RE-TEAR AND RE-OPERATION RATES FOR PEDIATRIC AND ADOLESCENT ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

BACKGROUND Anterior cruciate ligament (ACL) injuries have become increasingly common in pediatric and adolescent patients over the last several decades, as this population has become more involved in athletic competition. ACL injuries in skeletally immature patients had historically been treated conservatively with bracing and activity modification; however, poor outcomes including extensive chondral and meniscal damage, increased recurrent instability, and increased sports drop out rates have been observed. Recognition of these poor outcomes has led to a shift towards early operative treatment, resulting in a significant rise in the number of pediatric ACL reconstructions being performed. Yet, a higher failure rate has been noted in this younger population within larger adult cohort studies. The purpose of this study was to evaluate the re-tear and re-operation rates in pediatric and adolescent ACL reconstruction. METHODS The was a retrospective review of pediatric and adolescent patients treated at a single tertiary children’s hospital for ACL reconstruction from 2011 to 2017 by the same pediatric orthopedic surgeon. Review of the electronic medical record was performed to obtain patient demographics, preoperative clinical and radiographic findings, operative notes, and postoperative outcomes. Re-tear and re-operation rates were calculated. RESULTS A total of 308 patients were identified during the study period of which sixty-six percent were female. The mean age of patients was 15.8 years with a mean follow-up of 1.8 +/- 0.8 years. Two-hundred fifty-three hamstring autografts (mean age 15.7+/- 4.1 years) and 55 bone tendon bone autograft (mean age 16.9 +/- 1.45 years) were performed. Two hundred forty-three patents had adult-style reconstructions performed, 40 had transphyseal reconstructions, 24 had partial transphyseal reconstruction, and 1 patient had an all-epiphyseal reconstruction. Average hamstring graft size was 8.3 mm +/- 0.5 mm and all BTB graft were 9 mm. The overall graft re-tear rate was 8.2%. The overall re-operation rate was 13.2% (17 revisions, 5 medial meniscus repairs, 3 I+D’s, 2 cyclops debridements, 1 removal of hardware, and 1 manipulation under anesthesia). The highest re-tear (12.5%) and re-operation (22.5%) rates were found in patients who underwent a transphyseal reconstruction. No growth disturbances which required surgical intervention were noted. CONCLUSIONS / SIGNIFICANCE Pediatric and adolescent ACL reconstruction can be performed safely without a risk of growth disturbance. Patients had a high re-tear and re-operation rate; particularly in patients who underwent transphyseal reconstruction. Strategies must be developed to decrease the re-tear and re-operation rate in this population.

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Is Edema at the Posterior Medial Tibial Plateau Indicative of Ramp Lesion? An Examination of 852 Patients with Anterior Cruciate Ligament Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00132 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0013

Author(s):

Neil Kumar ◽

Tiahna Spencer ◽

Edward Hochman ◽

Mark P. Cote ◽

Robert A. Arciero ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Tibial Plateau ◽

Cruciate Ligament ◽

Mechanism Of Injury ◽

Medial Tibial Plateau ◽

Meniscal Tears ◽

Ramp Lesion ◽

Anterior Cruciate ◽

Operative Notes

Objectives: Meniscal injuries are commonly observed with anterior cruciate ligament (ACL) deficiency. A subset of these injuries includes tears of the medial meniscus at the posterior meniscocapsular junction, or ramp lesions. Biomechanical studies have indicated that ramp injuries may compromise anterior stability of the knee, even after ACL reconstruction (ACLR). These lesions are not consistently diagnosed with magnetic resonance imaging (MRI). One criterion that shows promise is the presence of posterior medial tibial plateau (PMTP) edema. A correlation of PMTP edema and peripheral posterior horn medial meniscal injuries has been observed in the literature. We evaluated a consecutive series of patients who underwent ACLR for incidence of ramp tears. These patients were then compared to patients with non-ramp (meniscal body) medial meniscal tears. The utility of PMTP edema on preoperative MRI for ramp tear diagnosis was then determined. Methods: A retrospective chart review via an institutional database search identified 892 patients who underwent ACLR by one of two senior authors (R.A.A., C.E.) between January 2006 and June 2016. Operative notes identified patients diagnosed arthroscopically with medial meniscal lesions, including ramp lesions. Arthroscopic identification was the gold standard for diagnosis of both ramp and non-ramp (meniscal body) tears. Demographic information such as age, sex, laterality, mechanism of injury (contact/noncontact), sport, revision procedure, multi-ligament procedure, time to MRI, and time to surgery were recorded. Patients without available operative records were excluded. Preoperative MRIs were obtained for all patients and reviewed by an orthopaedic sports medicine fellow for PMTP edema. Axial, coronal, and sagittal T2 and proton-density sequences were utilized. A MRI was considered positive if edema was detected in 2 different planes of sequences. Differences between groups were analyzed with two-sample t test or Chi square test Univariate and multivariate logistic regression models analyzed the relationships among patient factors, MRI findings, and ramp lesions. Results: 852 patients met the inclusion criteria for analysis. 307 patients were diagnosed with medial meniscal tear at the time of ACLR, 127 of which were ramp lesions. The overall incidence of ramp tear was 14.9% and consisted of 41.4% of all medial meniscal tears. Patients with ramp tears were mean 7.5 years younger than patients with meniscal body tears ( p<0.01). There was no difference between the groups in regard to mechanism of injury, revision surgery, or multi-ligamentous injury. Patients with delayed ACLR were at 3.3x greater odds ( p<0.01) of having meniscal body tear compared to ramp lesion. MRI was available for review in 178 patients, 97 of whom had positive MRI for PMTP edema. Sensitivity and specificity of PMTP edema for ramp tear was 66.3% and 55.1%, respectively. Of patients with PMTP edema, 54.6% had ramp lesions and 45.4% had non-ramp tears ( p<0.01). Patients with preoperative MRI positive for PMTP edema were at 2.1 times greater odds ( p<0.01) of having sustained a ramp tear compared to a meniscal body tear. Conclusion: The incidence of ramp tear was 14.9% and was more prevalent in younger patients. Delayed ACLR resulted in 3.3x greater odds of meniscal body tears compared to ramp tears. Patients with PMTP edema on preoperative MRI were at 2.1x greater odds to have ramp lesions compared to a meniscal body tears at the time of ACL reconstruction.

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Anterolateral ligament of the knee: back to the future in anterior cruciate ligament reconstruction

Orthopedic Reviews ◽

10.4081/or.2015.5773 ◽

2015 ◽

Vol 7 (2) ◽

Cited By ~ 12

Author(s):

Davide Edoardo Bonasia ◽

Andrea D'Amelio ◽

Pietro Pellegrino ◽

Federica Rosso ◽

Roberto Rossi

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Double Bundle ◽

Anterolateral Ligament ◽

Rotational Instability ◽

Small Subset ◽

Acl Injuries ◽

Anterior Cruciate ◽

Double Bundle Acl Reconstruction

Although the importance of the anterolateral stabilizing structures of the knee in the setting of anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take into consideration the anterolateral structures when performing an ACL reconstruction. Anatomic single or double bundle ACL reconstruction will improve knee stability, but a small subset of patients may experience some residual anteroposterior and rotational instability. For this reason, some researchers have turned again towards the anterolateral aspect of the knee and specifically the anterolateral ligament. The goal of this review is to summarize the existing knowledge regarding the anterolateral ligament of the knee, including anatomy, histology, biomechanics and imaging. In addition, the most common anterolateral reconstruction/tenodesis techniques are described together with their respective clinical outcomes.

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Outcomes of Quadriceps Tendon With Patellar Bone Block Anterior Cruciate Ligament Reconstruction in Adolescent Patients With a Minimum 2-Year Follow-up

The American Journal of Sports Medicine ◽

10.1177/0363546519885371 ◽

2019 ◽

Vol 48 (1) ◽

pp. 93-98 ◽

Cited By ~ 4

Author(s):

Alexia G. Gagliardi ◽

Patrick M. Carry ◽

Harin B. Parikh ◽

Jay C. Albright

Keyword(s):

Acl Reconstruction ◽

Graft Failure ◽

Cruciate Ligament ◽

Return To Sport ◽

Quadriceps Tendon ◽

Acl Injuries ◽

Patient Reported ◽

Adolescent Patients ◽

Anterior Cruciate

Background: The incidence of anterior cruciate ligament (ACL) injury in the adolescent population is increasing. The quadriceps tendon–patellar bone autograft (QPA) has been established as a reliable graft choice for ACL reconstruction in the adult population. Purpose: To investigate graft failure, ability to return to sport, patient-reported functional outcomes, joint laxity, and subsequent injury among adolescent patients >2 years after primary ACL reconstruction with the QPA. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients who underwent QPA ACL reconstruction performed by a single surgeon were identified from an existing database. Information available in the database included demographics, concomitant/subsequent injuries, surgical procedures, graft failure, return to sport, and Lachman examination collected by medical record review. Pediatric International Knee Documentation Committee (Pedi-IKDC) and Lysholm scores were collected by telephone or during a clinic visit >2 years postoperatively. Results: The final cohort included 81 of 104 consecutive adolescent patients aged 10 to 18 years (mean ± SD, 15.9 ± 1.7 years at the time of surgery) for whom follow-up information was collected at >2 years after surgery. The cumulative incidence of graft failure within the 36-month follow-up period was 1.2% (95% CI, 0.1%-11.4%). The rate of ipsilateral non-ACL injuries was similar (1.2%; 95% CI, 0.2%-7.6%). Contralateral ACL and non-ACL injuries requiring surgical intervention were documented in 9.8% (95% CI, 4.9%-19.5%). The median Pedi-IKDC score was 94 (interquartile range, 89-98). The median Lysholm score was 99.5 (interquartile range, 89.0-100.0). At 36 months after surgery, 87.9% (95% CI, 81.4%-94.9%) of individuals had returned to play. Conclusion: The quadriceps tendon–patellar autograft is a novel graft that demonstrates excellent stability and favorable patient-reported outcomes. Based on these results, the QPA is a reliable choice for primary ACL reconstruction in adolescent patients.

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The Role of Patient Characteristics in the Success of Nonoperative Treatment of Anterior Cruciate Ligament Injuries

The American Journal of Sports Medicine ◽

10.1177/0363546520917386 ◽

2020 ◽

Vol 48 (7) ◽

pp. 1657-1664 ◽

Cited By ~ 1

Author(s):

Jelle P. van der List ◽

Frans J.A. Hagemans ◽

Dirk Jan Hofstee ◽

Freerk J. Jonkers

Keyword(s):

Anterior Cruciate Ligament ◽

Multivariate Analysis ◽

Physical Therapy ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Patient Characteristics ◽

Nonoperative Treatment ◽

Activity Level ◽

Acl Injuries ◽

Anterior Cruciate

Background: Anterior cruciate ligament (ACL) tears can either be treated nonoperatively with physical therapy and then treated operatively if persistent instability is present, or be directly treated operatively. Advantages of early ACL reconstruction surgery include shorter time from injury to surgery and potentially fewer meniscal injuries, but performing early ACL reconstruction in all patients results in surgery in patients who might not need ACL reconstruction. It is important to assess in which patients nonoperative treatment is successful and which patients will require ACL reconstruction and thus might be better treated surgically in an earlier phase. Purpose: To identify patient characteristics that predict the success of nonoperative treatment. Study Design: Cohort study (Prognosis); Level of evidence, 2. Methods: All patients with complete ACL injuries who were evaluated between 2014 and 2017 at our clinic were included. The minimum follow-up was 2 years. The initial treatment and ultimate ACL reconstruction were reviewed. Univariate analysis was performed using Mann-Whitney U tests and chi-square tests and multivariate analysis using binary logistic regression. Results: A total of 448 patients were included with a median age of 26 years and median Tegner level of 7 and mean Tegner level of 6.4. At initial consultation, 210 patients (47%) were treated nonoperatively with physical therapy and 126 of these patients (60%) ultimately required ACL reconstruction. Nonoperative treatment failed in 88.9% of patients <25 years of age, 56.0% of patients 25 to 40 years, and 32.9% of patients >40 years ( P < .001); and 41.9% of patients with Tegner level 3 to 6, and 82.8% of patients with Tegner level 7 to 10. Age <25 years (odds ratio [OR], 7.4; P < .001) and higher Tegner levels (OR, 4.2; P < .001) were predictive of failing nonoperative treatment in multivariate analysis. Patients in the failed nonoperative group had longer time from diagnosis to surgery than the direct reconstruction group (6.2 vs 2.2 months; P < .001), and more frequently had new meniscal injuries (17.4% vs 3.1%; P < .001) at surgery. Conclusion: Nonoperative treatment of ACL injuries failed in 60% of patients and was highly correlated with age and activity level. In patients aged 25 years or younger or participating in higher-impact sports, early ACL reconstruction should be considered to prevent longer delay between injury and surgery, as well as new meniscal injuries.

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Secondary Meniscal Tears in Patients With Anterior Cruciate Ligament Injury: Relationship Among Operative Management, Osteoarthritis, and Arthroplasty at 18-Year Mean Follow-up

The American Journal of Sports Medicine ◽

10.1177/0363546519844481 ◽

2019 ◽

Vol 47 (7) ◽

pp. 1583-1590 ◽

Cited By ~ 4

Author(s):

Michella H. Hagmeijer ◽

Mario Hevesi ◽

Vishal S. Desai ◽

Thomas L. Sanders ◽

Christopher L. Camp ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Meniscal Tear ◽

Acl Injury ◽

Nonoperative Treatment ◽

Meniscal Tears ◽

Acl Injuries ◽

Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injury is one of the most frequent orthopaedic injuries and reasons for time loss in sports and carries significant implications, including posttraumatic osteoarthritis (OA). Instability associated with ACL injury has been linked to the development of secondary meniscal tears (defined as tears that develop after the initial ACL injury). To date, no study has examined secondary meniscal tears after ACL injury and their effect on OA and arthroplasty risk. Purpose: To describe the rates and natural history of secondary meniscal tears after ACL injury and to determine the effect of meniscal tear treatment on the development of OA and conversion to total knee arthroplasty (TKA). Study Design: Cohort study; Level of evidence, 3. Methods: A geographic database of >500,000 patients was reviewed to identify patients with primary ACL injuries between January 1, 1990, and December 31, 2005. Information was collected with regard to ACL injury treatment, rates/characteristics of the secondary meniscal tears, and outcomes, including development of OA and conversion to TKA. Kaplan-Meier and adjusted multivariate survival analyses were performed to test for the effect of meniscal treatment on survivorship free of OA and TKA. Results: Of 1398 primary ACL injuries, the overall rate of secondary meniscal tears was 16%. Significantly lower rates of secondary meniscal tears were noted among patients undergoing acute ACL reconstruction within 6 months (7%) as compared with patients with delayed ACL reconstruction (33%, P < .01) and nonoperative ACL management (19%, P < .01). Of the 235 secondary meniscal tears identified (196 patients), 11.5% underwent repair, 73% partial meniscectomy, and 16% were treated nonoperatively. Tears were most often medial in location (77%) and complex in morphology (56% of medial tears, 54% of lateral tears). At the time of final follow-up, no patient undergoing repair of a secondary meniscal tear (0%) underwent TKA, as opposed to 10.9% undergoing meniscectomy and 6.1% receiving nonoperative treatment ( P = .28). Conclusion: Secondary meniscal tears after ACL injury are most common among patients undergoing delayed surgical or nonoperative treatment of their primary ACL injuries. Secondary tears often present as complex tears of the medial meniscus and result in high rates of partial meniscectomy.

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Incidence of Second Anterior Cruciate Ligament Tears (1990-2000) and Associated Factors in a Specific Geographic Locale

The American Journal of Sports Medicine ◽

10.1177/0363546517694026 ◽

2017 ◽

Vol 45 (7) ◽

pp. 1567-1573 ◽

Cited By ~ 22

Author(s):

Nathan D. Schilaty ◽

Nathaniel A. Bates ◽

Thomas L. Sanders ◽

Aaron J. Krych ◽

Michael J. Stuart ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Patellar Tendon ◽

Cruciate Ligament ◽

Population Based ◽

Contralateral Side ◽

Activity Level ◽

Acl Injuries ◽

Acl Tear ◽

Anterior Cruciate

Background: Second anterior cruciate ligament (ACL) tears after reconstruction occur at a reported rate of 20% to 30%. This high frequency indicates that there may be factors that predispose an athlete to graft failure and ACL tears of the contralateral knee. Purpose: To determine the incidence of second ACL injuries in a geographic population-based cohort over a 10-year observation period. Study Design: Descriptive epidemiological study. Methods: International Classification of Diseases, 9th Revision (ICD-9) codes relevant to the diagnosis of an ACL tear and the procedure code for ACL reconstruction were searched across the Rochester Epidemiology Project, a multidisciplinary county database, between the years of 1990 and 2000. This cohort of patients was tracked for subsequent ACL injuries through December 31, 2015. The authors identified 1041 patients with acute, isolated ACL tears. These patients were stratified by primary and secondary tears, sex, age, activity level, side of injury, sex by side of injury, and graft type. Results: Of the 1041 unique patients with a diagnosed ACL tear in Olmsted County, Minnesota, from 1990 to 2000, there were 66 (6.0%) second ACL tears; 66.7% of these tears occurred on the contralateral side. A second ACL injury was influenced by graft type ( P < .0001), election of ACL reconstruction ( P = .0060), and sex by side of injury ( P = .0072). Nonparametric analysis of graft disruption by graft type demonstrated a higher prevalence of second ACL tears with allografts compared with hamstring ( P = .0499) or patellar tendon autografts ( P = .0012). Conclusion: The incidence of second ACL tears in this population-based cohort was 6.0%, with 66.7% of these tears occurring on the contralateral side from the original injury. There was a high population incidence of second ACL injuries in female patients younger than age 20 years. The utilization of patellar tendon autografts significantly reduced the risk of second ACL injuries compared with allografts or hamstring autografts in this cohort.

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Results of meniscectomy and meniscal repair in anterior cruciate ligament reconstruction

Joints ◽

10.11138/jts/2015.3.3.151 ◽

2015 ◽

Vol 03 (03) ◽

pp. 151-157 ◽

Cited By ~ 5

Author(s):

Davide Deledda ◽

Federica Rosso ◽

Umberto Cottino ◽

Davide Bonasia ◽

Roberto Rossi

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Ligament Reconstruction ◽

Medial Meniscus ◽

Cruciate Ligament ◽

Meniscal Repair ◽

Meniscal Tears ◽

Acl Injuries ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate

Meniscal tears are commonly associated with anterior cruciate ligament (ACL) injuries. A deficient medial meniscus results in knee instability and could lead to higher stress forces on the ACL reconstruction.Comparison of results in meniscectomy and meniscal repairs revealed worse clinical outcomes in meniscectomy, but higher re-operation rates in meniscal repairs. Our aim was to review the results of ACL reconstruction associated with meniscectomy or meniscal repair.

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Failure and Reoperation Rates Following Arthroscopic Primary Repair Versus Reconstruction of the Anterior Cruciate Ligament

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00297 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0029

Author(s):

Jelle P. van der List ◽

Anne Jonkergouw ◽

Gregory S. DiFelice

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Primary Repair ◽

Cruciate Ligament ◽

Treatment Algorithm ◽

Acl Injuries ◽

Graft Rupture ◽

Anterior Cruciate ◽

Reoperation Rates

Objectives: To compare the failure and reoperation rates of arthroscopic primary repair versus reconstruction of the anterior cruciate ligament (ACL). Methods: This study retrospectively reviewed all patients with ACL injury operatively treated between April 2008 and May 2016 by one surgeon. All patients with proximal tears were treated with primary repair using suture anchors, or otherwise underwent standard reconstruction. Patients were included if minimum two-year follow-up was present, and were excluded for multiligamentous injuries. Charts were reviewed and patients were contacted to assess failure (instability, graft rupture or revision), reoperation (other than revision), complications and contralateral failure. Results: 154 patients were included of which 56 underwent primary repair (36.4%). Mean age was 30 years (range 14-57), 70% was male and mean follow-up was 3 years (range 2-9). Patients undergoing ACL reconstruction were younger (28 vs. 33, p=0.002) and were more often male (77% vs. 59%, p=0.02). Failure rates were lower following primary repair (10.7%) than ACL reconstruction (12.2%) but this was not statistically significant (p=0.776). Also, no clinical relevant or statistical significant differences were found between repair and reconstruction in reoperations (7.1% each group), complications (1.8% vs. 3.1%, respectively) and contralateral failures (3.6% vs. 4.1%, respectively) (all p>0.99). With revision surgery, no complications were noted following primary repair revision (primary reconstruction; 0%) but 25% of revision reconstructions failed and 1 needed reoperation (8%). Conclusion: This study is the first study to compare the failure and reoperation rates following arthroscopic primary repair versus reconstruction in a large cohort of patients. With the treatment algorithm of primary repair for proximal avulsion tears and reconstruction of midsubstance tears, equivalent outcomes were noted between both treatments. Arthroscopic primary repair is a safe and good treatment for ACL injuries and has similar failure and reoperation rates when compared to the gold standard of ACL reconstruction.

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Intra-Articular Cytokine Levels in Adolescent Patients after Anterior Cruciate Ligament Tear

Mediators of Inflammation ◽

10.1155/2018/4210593 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Marco Bigoni ◽

Marco Turati ◽

Giovanni Zatti ◽

Marta Gandolla ◽

Paola Sacerdote ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Meniscal Tear ◽

Skeletally Immature ◽

Growth Plates ◽

Acl Injuries ◽

Acl Tear ◽

Adolescent Patients ◽

Open Growth Plates ◽

Anterior Cruciate

The treatment of anterior cruciate ligament (ACL) injuries in children and adolescents is challenging. Preclinical and clinical studies investigated ACL repairing techniques in skeletally immature subjects. However, intra-articular bioenvironment following ACL tear has not yet been defined in skeletally immature patients. The aim of this study was to measure cytokine concentrations in the synovial fluid in adolescent population. Synovial levels of IL-1β, IL-1ra, IL-6, IL-8, IL-10, and TNF-α were measured in 17 adolescent patients (15 boys) with ACL tears who underwent ACL reconstruction including acute (5), subacute (7), and chronic (5) phases. Femoral growth plates were classified as “open” in three patients, “closing” in eight, and “closed” in six. Eleven patients presented an ACL tear associated with a meniscal tear. The mean Tegner and Lysholm scores (mean±SD) of all patients were 8 ± 1 and 50.76 ± 26, respectively. IL-8, TNF-α, and IL-1β levels were significantly greater in patients with “open” physes. IL-1ra and IL-1β levels were significantly higher in patients with ACL tear associated with a meniscal tear. Poor Lysholm scores were associated with elevated IL-6 and IL-10 levels. IL-10 levels positively correlated with IL-6 and IL-8 levels, whereas TNF-α concentration negatively correlated with IL-6 levels. Skeletally immature patients with meniscal tears and open growth plates have a characteristic cytokine profile with particularly elevated levels of proinflammatory cytokines including IL-8, TNF-α, and IL-1β. This picture suggests that the ACL tear could promote an intra-articular catabolic response in adolescent patients greater than that generally reported for adult subjects. The study lacks the comparison with synovial samples from healthy skeletally immature knees due to ethical reasons. Overall, these data contribute to a better knowledge of adolescent intra-articular bioenvironment following ACL injuries.

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SINGLE-LEG HOP TESTING AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IS NOT PREDICTIVE OF GRAFT RUPTURE IN ADOLESCENT PATIENTS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00153 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0015

Author(s):

Jie J Yao ◽

Jordan Snetselaar ◽

Gregory A. Schmale ◽

Michael Saper

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

High Risk Population ◽

Entire Cohort ◽

Hop Tests ◽

Graft Rupture ◽

Adolescent Patients ◽

The Mean ◽

Anterior Cruciate

Background: Safe return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction is difficult to determine in adolescent patients. Return of strength and dynamic knee stability can be assessed with functional single-leg hop testing as part of a formal RTS assessment. However, it is unclear whether performance during single-leg hop testing can predict future ACL graft rupture. Hypothesis/Purpose: To investigate differences in single-leg hop testing between adolescent patients who experienced a graft rupture after ACL reconstruction and those that did not. Methods: A retrospective review of adolescent patients whom underwent primary ACL reconstruction with a hamstring (HS) autograft identified 16 patients (10 girls, 6 boys) with single-leg hop testing data prior to graft failure. A nearest neighbor match algorithm was used to age-, sex-, surgeon-, and graft-match 16 patients without graft rupture. All patients followed a standardized rehabilitation protocol following surgery. As part of a formal RTS test, assessment of function and dynamic strength/stability was performed using 4 different single-leg hop tests: single hop for distance, triple hop for distance, triple crossover hop for distance, and timed hop. The recovery of muscle strength was defined by a limb symmetry index (LSI) ≥ 90%. Bivariate analyses were performed to compare the two groups. Results: The mean age of the entire cohort at the time of surgery was 14.6 ± 1.5 years. Patients completed their RTS test at 29.0 ± 5.4 weeks. There were no statistically significant differences in demographics, graft size, or time to RTS test between groups. There were no statistically significant differences in LSIs on the single hop (p=0.90), triple hop (p=0.36), crossover hop (p=0.41), or timed hop (p=0.48). The mean LSIs on each of the four hop tests were 92.3 ± 14.7, 95.1 ± 6.1, 95.8 ± 7.1, and 98.6 ± 7.9, respectively. Passing rates were similar between groups (p=0.54). Conclusion: Performance on single-leg hop tests 6 months after surgery is not predictive of graft rupture following ACL reconstruction with HS autograft in adolescent patients. Further investigation of alternative RTS measures and different time frames for testing in this high-risk population is needed.

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