scholarly journals Patient-Reported Outcomes, Return-to-Sport Status, and Reinjury Rates After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes: Minimum 2-Year Follow-up

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096447
Author(s):  
Lilah Fones ◽  
Regina O. Kostyun ◽  
Andrew D. Cohen ◽  
J. Lee Pace
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Knee Function ◽  
Adolescent Athletes ◽  
Patient Reported ◽  
Adolescent Patients ◽  
Anterior Cruciate

Background: Significant variation exists in the published rates of return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR). Functional outcomes and psychological response to injury have been implicated as factors that influence return to sport. Most studies focus on patients aged in the mid-20s, and less is known about this topic in adolescents. Purpose: To report midterm ACLR results for adolescent patients with regard to return to primary sport, patient-reported outcomes, and reinjury rate. Study Design: Case-control study; Level of evidence, 3. Methods: Adolescent athletes were contacted at a minimum of 2 years after ACLR. Patients completed 2 patient-reported outcome measures, the ACL--Return to Sport After Injury (ACL-RSI) and the International Knee Documentation Committee (IKDC) subjective form, and responded to questions regarding preinjury primary sport and level of competition, post-ACLR return to primary sport status, and reinjury. Results: A total of 74 patients (mean ± SD surgical age, 15.9 ± 1.5 years; follow-up age, 19.9 ± 2.0 years; response rate, 24.5%) completed the surveys at a mean of 4.0 ± 2.0 years after primary ACLR. Outcome scores averaged 90.3 ± 12.3 for IKDC and 81.6 ± 20.4 for ACL-RSI. Questionnaire responses indicated that 27.0% of patients did not return to or sustain primary sport participation after ACLR; the principal reasons were poor knee function, team/training change, and fear of another injury. Both IKDC and ACL-RSI scores were statistically lower in patients who did not successfully return to their primary sport in contrast to patients who successfully resumed their primary sport (IKDC, P = .026; ACL-RSI, P < .001). IKDC and ACL-RSI scores were moderately positively correlated with one another ( r Spearman = 0.60). There were 18 patients (reinjury rate, 24.3%) who suffered another ACL injury; 8 of these injuries included ipsilateral ACL graft tear (retear rate, 10.8%). Conclusion: In our cohort, 73% of adolescent patients successfully returned to their primary preinjury sport at a minimum of 2 years after ACLR. Both knee function and psychological responses to injury were important in determining an adolescent athlete’s return to sport. The findings support the use of the IKDC and ACL-RSI at midterm follow-up, with higher scores associated with a greater likelihood of adolescent patients returning to sport after ACLR.

scholarly journals Satisfactory patient-reported outcomes at 5 years following primary repair with suture tape augmentation for proximal anterior cruciate ligament tears

2021 ◽  
Author(s):  
Graeme P. Hopper ◽  
Joanna M. S. Aithie ◽  
Joanne M. Jenkins ◽  
William T. Wilson ◽  
Gordon M. Mackay
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patient Reported Outcomes ◽  
Primary Repair ◽  
Cruciate Ligament ◽  
Acl Repair ◽  
Patient Reported ◽  
Activity Scale ◽  
Anterior Cruciate ◽  
Suture Tape

Abstract Purpose An enhanced understanding of anterior cruciate ligament (ACL) healing and advancements in arthroscopic instrumentation has resulted in a renewed interest in ACL repair. Augmentation of a ligament repair with suture tape reinforces the ligament and acts as a secondary stabilizer. This study assesses the 5-year patient-reported outcomes of primary repair with suture tape augmentation for proximal ACL tears. Methods Thirty-seven consecutive patients undergoing ACL repair with suture tape augmentation for an acute proximal rupture were prospectively followed up for a minimum of 5 years. Patients with midsubstance and distal ruptures, poor ACL tissue quality, retracted ACL remnants and multiligament injuries were excluded. Patient-reported outcome measures were collated using the Knee Injury and Osteoarthritis Outcomes Score (KOOS), Visual Analogue Pain Scale (VAS-pain), Veterans RAND 12-Item Health Survey (VR-12) and the Marx Activity Scale. Patients with a re-rupture were identified. Results Three patients were lost to follow-up leaving 34 patients in the final analysis (91.9%). The mean KOOS at 5 years was 88.5 (SD 13.8) which improved significantly from 48.7 (SD 18.3) preoperatively (p < 0.01). The VAS score improved from 2.3 (SD 1.7) to 1.0 (SD 1.5) and the VR-12 score improved from 35.9 (SD 10.3) to 52.4 (SD 5.9) at 5 years (p < 0.01). However, the Marx activity scale decreased from 12.4 (SD 3.4) pre-injury to 7.3 (SD 5.2) at 5 years (p = 0.02). Six patients had a re-rupture (17.6%) and have since undergone a conventional ACL reconstruction for their revision surgery with no issues since then. These patients were found to be younger and have higher initial Marx activity scores than the rest of the cohort (p < 0.05). Conclusion Primary repair with suture tape augmentation for proximal ACL tears demonstrates satisfactory outcomes in 28 patients (82.4%) at 5-year follow-up. Six patients sustained a re-rupture and have no ongoing problems following treatment with a conventional ACL reconstruction. These patients were significantly younger and had higher initial Marx activity scores. Level of evidence Level IV.

Twenty-Year Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Prospectively Collected Data

2021 ◽  
pp. 036354652110273
Author(s):  
Joshua S. Everhart ◽  
Sercan Yalcin ◽  
Kurt P. Spindler
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Function ◽  
Increased Risk ◽  
Patient Reported ◽  
The Mean ◽  
Anterior Cruciate

Background: Several long-term (≥20 years) follow-up studies after anterior cruciate ligament (ACL) reconstruction have been published in recent years, allowing for a systematic evaluation of outcomes. Purpose: To summarize outcomes at ≥20 years after ACL reconstruction and identify patient and surgical factors that affect these results. Study Design: Systematic review; Level of evidence, 4. Methods: Prospective studies of primary ACL reconstructions with hamstring or bone–patellar tendon—bone (BTB) autograft via an arthroscopic or a mini-open technique and with a mean follow-up of ≥20 years were identified. When possible, the mean scores for each outcome measure were calculated. Factors identified in individual studies as predictive of outcomes were described. Results: Five studies met the inclusion and exclusion criteria with a total of 2012 patients. The pooled mean follow-up for patient-reported outcome measures was 44.2% (range, 29.6%-92.7%) and in-person evaluation was 33.2% (range, 29.6%-48.9%). Four studies (n = 584) reported graft tears at a mean rate of 11.8% (range, 2%-18.5%) and 4 studies (n = 773) reported a contralateral ACL injury rate of 12.2% (range, 5.8%-30%). Repeat non-ACL arthroscopic surgery (4 studies; n = 177) to the ipsilateral knee occurred in 10.4% (range, 9.5%-18.3%) and knee arthroplasty (1 study; n = 217) in 5%. The pooled mean of the International Knee Documentation Committee subjective knee function (IKDC) score was 79.1 (SD, 21.8 [3 studies; n = 644]). In 2 studies (n?= 221), 57.5% of patients continued to participate in strenuous activities. The IKDC-objective score was normal or nearly normal in 82.3% (n = 496; 3 studies), with low rates of clinically significant residual laxity. Moderate-severe radiographic osteoarthritis (OA) (IKDC grade C or D) was present in 25.9% of patients (n = 605; 3 studies). Medial meniscectomy is associated with increased risk of radiographic OA. Radiographic OA severity is associated with worse patient-reported knee function, but the association with knee pain is unclear. Conclusion: Currently available prospective evidence for ACL reconstruction with hamstring or BTB autograft provides several insights into outcomes at 20 years. The rates of follow-up at 20 years range from 30% to 93%. IKDC-objective scores were normal or nearly normal in 82% and the mean IKDC-subjective score was 79 points.

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

2019 ◽  
Vol 48 (1) ◽  
pp. 93-98 ◽  
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.

How Is Psychological Outcome Related to Knee Function and Return to Sport Among Adolescent Athletes After Anterior Cruciate Ligament Reconstruction?

2019 ◽  
Vol 47 (7) ◽  
pp. 1567-1575 ◽  
Author(s):  
Susanne Beischer ◽  
Eric Hamrin Senorski ◽  
Christoffer Thomeé ◽  
Kristian Samuelsson ◽  
Roland Thomeé
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Self Efficacy ◽  
Muscle Function ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Adolescent Athletes ◽  
Psychological Outcome ◽  
Patient Reported ◽  
Anterior Cruciate

Background: Adult patients who succeed in returning to their preinjury levels of sport after anterior cruciate ligament (ACL) reconstruction have been characterized by a more positive psychological response. It is not known whether this relationship is valid for adolescent athletes. Purpose: To investigate psychological readiness to return to sport, knee-related self-efficacy, and motivation among adolescent (15-20 years old) and adult (21-30 years old) athletes after ACL reconstruction. A further aim was to compare athletes (15-30 years old) who had recovered their muscle function and returned to sport with athletes who had not. Study Design: Case-control study; Level of evidence, 3. Methods: Data were extracted from a rehabilitation-specific register 8 and 12 months after ACL reconstruction. Athletes previously involved in knee-strenuous sport who had undergone primary ACL reconstruction were included. Data comprised psychological patient-reported outcomes and results from 5 tests of muscle function. Comparisons were performed between age groups, between athletes who had and had not recovered their muscle function, and between patients who had returned to sport and not. Results: In all, 384 (50% females) and 271 athletes (52% females) were included at the 8- and 12- month follow-ups, respectively. Enhanced self-efficacy was reported at both follow-ups by adolescents and by athletes who had recovered their muscle function. Athletes who had recovered their muscle function reported higher ( P = .0007) motivation to achieve their goals. Subgroup analyses on patient sex revealed findings similar to those in the main analyses for females but not for males. Moreover, adolescent and adult athletes who had returned to sport reported significantly higher levels on the Knee Self-Efficacy Scale and the ACL–Return to Sport After Injury scale at both follow-ups. Conclusion: Adolescent athletes, especially females, perceived enhanced self-efficacy, had a higher return-to-sport rate, and were more motivated to reach their goals after ACL reconstruction compared with adults. Regardless of age, athletes who had returned to sport and athletes with more symmetrical muscle function had a stronger psychological profile.

scholarly journals 726 Return to Sport, Patient Reported Outcomes and Satisfaction Following Anterior Cruciate Ligament Reconstruction

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
C Simpson ◽  
D MacDonald ◽  
J Keating
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patient Satisfaction ◽  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Healthcare Experience ◽  
Patient Reported ◽  
Anterior Cruciate

Abstract Introduction Anterior Cruciate Ligament(ACL) rupture is a common sporting injury. Return to sport is a key objective for patients. The aim of this study was to investigate return to pre-injury level sport at 12- and 24-months post reconstruction and to relate this to types of sport and to patient satisfaction. Method A questionnaire was developed, piloted, and then completed by 77 patients that had undergone ACL reconstruction between 2013-2016. Results 30% of patients returned to pre-injury level of sport at 12 months and 43% by 24 months’ post ACL reconstruction. There was a significant(P = 0.037) relationship between the type of sports that participants played prior to injury and the return to pre-injury level. Sports that involved jumping, hard pivoting and cutting were associated with a lower rate of return to sport. General health profile of the patients was found to be significantly higher in patients that returned to sport(P = 0.024). There was a significant association with return to sport and higher satisfaction and healthcare experience score(P = 0.001). Conclusions Patient satisfaction correlated with return to sport. This was inversely related to sports involving jumping, hard pivoting and cutting. Which further illustrates how patient satisfaction post ACL reconstruction was linked to type of sport.

scholarly journals Outcomes and Return to Sport After Revision Anterior Cruciate Ligament Reconstruction in Adolescent Athletes

2018 ◽  
Vol 6 (4) ◽  
pp. 232596711876488 ◽  
Author(s):  
Michael Saper ◽  
Stephanie Pearce ◽  
Joseph Shung ◽  
Robert Zondervan ◽  
Roger Ostrander ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patient Satisfaction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Activity Level ◽  
Common Mechanism ◽  
Adolescent Athletes ◽  
The Mean ◽  
Anterior Cruciate

Background: The number of adolescent anterior cruciate ligament (ACL) injuries is rising with increased participation in higher level athletics at earlier ages. With an increasing number of primary ACL reconstructions (ACLRs) comes a rise in the incidence of revision ACLRs. Purpose: To evaluate the clinical results of revision ACLR across a group of high-level adolescent athletes with at least 2-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of 21 adolescent athletes (age range, 10-19 years) who underwent revision ACLR with at least 2-year follow-up was conducted. Patient-reported outcome measures (PROMs) included the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Lysholm knee scoring scale, Tegner activity level scale, and modified Cincinnati Knee Rating System. Return to sport (RTS) and overall patient satisfaction were also assessed. Results: The mean age at the time of surgery was 16.5 years (range, 14-19 years), and the mean follow-up was 46.4 months (range, 24-97 months); 42.9% of patients were female, and 52.4% of patients participated in collision sports. The mean time to failure after primary ACLR was 13.1 ± 8.0 months, and the most common mechanism of failure was noncontact in at least 66.7% of cases. The revision graft type included bone–patellar tendon–bone (BPTB) in 71.4% of cases; 26.7% of BPTB grafts were from the contralateral extremity. Concomitant procedures were performed for intra-articular lesions in 71.4% of patients. The mean patient satisfaction rate was 95.3%. There were 3 cases of a graft reinjury at a mean of 25 months postoperatively. The mean PROM scores were as follows: IKDC, 87.5 ± 12.7; Tegner, 7.2 ± 2.0; Lysholm, 93.7 ± 9.8; and Cincinnati, 93.4 ± 10.0. Of those attempting to RTS, 68.4% of patients successfully returned at the same level of competition. Patients with a lateral compartment chondral injury were less likely to RTS ( P < .05). Independent variables shown to have no significant relationship to PROMs or RTS included age, follow-up, sport classification, associated meniscal tears, revision graft size/type, and concomitant procedures. Conclusion: Revision ACLR can be an effective surgical option in adolescents participating in collision and contact sports, with good to excellent subjective outcome scores. At a minimum 2-year follow-up, a graft rupture after revision ACLR occurred in 14% of cases. Of the athletes attempting to RTS, 68.4% returned to their preinjury level of competition.

scholarly journals Clinical outcomes after anterior cruciate ligament injury: Panther Symposium ACL Injury Clinical Outcomes Consensus Group

2020 ◽  
Vol 5 (5) ◽  
pp. 281-294
Author(s):  
Eleonor Svantesson ◽  
Eric Hamrin Senorski ◽  
Kate E Webster ◽  
Jón Karlsson ◽  
Theresa Diermeier ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Clinical Outcomes ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Consensus Meeting ◽  
Comprehensive Assessment ◽  
Patient Reported ◽  
Anterior Cruciate

PurposeA stringent outcome assessment is a key aspect for establishing evidence-based clinical guidelines for anterior cruciate ligament (ACL) injury treatment. The aim of this consensus statement was to establish what data should be reported when conducting an ACL outcome study, what specific outcome measurements should be used and at what follow-up time those outcomes should be assessed.MethodsTo establish a standardised assessment of clinical outcome after ACL treatment, a consensus meeting including a multidisciplinary group of ACL experts was held at the ACL Consensus Meeting Panther Symposium, Pittsburgh, PA, USA, in June 2019. The group reached consensus on nine statements by using a modified Delphi method.ResultsIn general, outcomes after ACL treatment can be divided into four robust categories—early adverse events, patient-reported outcomes, ACL graft failure/recurrent ligament disruption, and clinical measures of knee function and structure. A comprehensive assessment following ACL treatment should aim to provide a complete overview of the treatment result, optimally including the various aspects of outcome categories. For most research questions, a minimum follow-up of 2 years with an optimal follow-up rate of 80% is necessary to achieve a comprehensive assessment. This should include clinical examination, any sustained re-injuries, validated knee-specific patient-reported outcomes and Health-Related Quality of Life questionnaires. In the mid-term to long-term follow-up, the presence of osteoarthritis should be evaluated.ConclusionThis consensus paper provides practical guidelines for how the aforementioned entities of outcomes should be reported and suggests the preferred tools for a reliable and valid assessment of outcome after ACL treatment.Level of EvidenceLevel V.

Revision Anterior Cruciate Ligament Reconstruction Outcomes at a Minimum of 5-Year Follow-Up: A Systematic Review

2018 ◽  
Vol 32 (03) ◽  
pp. 218-221 ◽  
Author(s):  
Lea Johnson ◽  
Robert Brophy ◽  
Ljiljana Bogunovic ◽  
Matthew Matava ◽  
Matthew Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Level Of Evidence ◽  
Revision Acl Reconstruction ◽  
Patient Reported ◽  
Anterior Cruciate

AbstractRevision anterior cruciate ligament (ACL) reconstruction typically has worse outcomes than primary reconstructions. Minimal long-term data exist regarding 5-year results. We chose to perform a systematic review to evaluate midterm (5-year) revision ACL reconstruction outcomes (patient-reported outcomes, reoperation, stability, arthritis) in comparison to primary ACL reconstructions at similar time points. Embase, Cochrane, and PubMed databases were queried, and four studies met the inclusion criteria. Two authors reviewed and performed data extraction. All were level 4 studies. Review of the studies demonstrated that results at 5 years are consistently worse than those noted in primary reconstructions for objective and patient-reported outcomes. Revision ACL reconstruction outcomes remain worse than primary reconstructions at midterm 5-year follow-up. The level of evidence is 4.

scholarly journals A Controlled Comparison of Microfracture, Debridement, and No Treatment of Concomitant Full-Thickness Cartilage Lesions in Anterior Cruciate Ligament–Reconstructed Knees: A Nationwide Prospective Cohort Study From Norway and Sweden of 368 Patients With 5-Year Follow-up

2018 ◽  
Vol 6 (8) ◽  
pp. 232596711878776 ◽  
Author(s):  
Svend Ulstein ◽  
Asbjørn Årøen ◽  
Lars Engebretsen ◽  
Magnus Forssblad ◽  
Stein Håkon Låstad Lygre ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cohort Study ◽  
Surgical Treatment ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Full Thickness ◽  
Cartilage Lesions ◽  
Patient Reported ◽  
Anterior Cruciate

Background: The effect of microfracture (MF) or surgical debridement of concomitant full-thickness cartilage lesions in anterior cruciate ligament–reconstructed knees on patient-reported outcomes remains to be determined. Purpose: To evaluate the effect of debridement or MF compared with no surgical treatment of concomitant full-thickness cartilage lesions on patient-reported outcomes 5 years after anterior cruciate ligament reconstruction (ACLR). Study Design: Cohort study; Level of evidence, 2. Methods: Included in this study were 644 patients who were registered in the Norwegian and the Swedish National Knee Ligament Registries from 2005 to 2008 as having undergone unilateral primary ACLR and having a concomitant full-thickness cartilage lesion (International Cartilage Repair Society [ICRS] grades 3-4). Of these patients, 129 were treated with debridement, 164 were treated with MF, and 351 received no surgical treatment simultaneously with ACLR. At 5-year follow-up, 368 (57%) patients completed results on the Knee injury and Osteoarthritis Outcome Score (KOOS). Multivariable linear regression was used to estimate the effect of surgical debridement or MF of concomitant full-thickness cartilage lesions on patient-reported outcomes 5 years after ACLR. Results: Compared with no surgical treatment, there were no unadjusted or adjusted effects of debridement or MF of concomitant full-thickness cartilage lesions on KOOS scores at 5-year follow-up. Conclusion: Compared with leaving concomitant full-thickness cartilage lesions untreated at the time of ACLR, debridement and MF showed no effect on patient-reported outcomes 5 years after surgery.

scholarly journals Association Between Psychological Readiness, Patient Reported Outcomes and Return to Sports Following Primary Anterior Cruciate Ligament Reconstruction: Readiness Outcomes Affecting Return-to-Sport (ROAR)

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0048
Author(s):  
Jessica Traver ◽  
Melissa Christino ◽  
Ryan Coene ◽  
Kathryn Williams ◽  
Dai Sugimoto ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Age Groups ◽  
Return To Sport ◽  
Functional Testing ◽  
Patient Reported ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction

Objectives: Successful return-to-sport (RTS) following anterior cruciate ligament (ACL) reconstruction can be affected by several variables, including a patient’s physical and psychological states throughout the rehabilitation process. Several studies have reported patients with increased fear-of-reinjury may be at risk for secondary injury following ACL reconstruction. The primary objective was to compare the relationship between ACL-RSI, Pedi-IKDC, Pedi-FABS, and PROMIS-Psychological Stress Experiences (PSE) across various age groups and graft types between patients undergoing primary ACL reconstruction at the 6 month post-operative visit. Secondary outcome was timing of RTS clearance. Methods: Patients prospectively enrolled were 8-30 years old who underwent primary ACL reconstruction at a large pediatric academic sports medicine center from August 2018 until February 2019. They were evaluated at their 6 month follow-up appointment and underwent functional RTS testing. Patients were divided into 3 groups based on their age: Pre-Adolescent (ages 8-14), Adolescent (ages 15-18), and Adult (ages >18) to reflect their psychological/emotional maturity. Demographic information, time to RTS clearance, and functional testing measurements were collected. Analysis included one-way ANOVA and Kruskal-Wallis tests. Results: A total of 100 patients were included in the study (57 males, 43 females; mean age, 17.3±2.9 years). RTS functional testing was performed at a mean of 6.3±0.7 months after primary ACL reconstruction. The 3 age groups consisted of Pre-Adolescent (n=13), Adolescent (n=62), and Adult (n=25). The graft types were HS (n=79), BTB (n=14), ITB (n=7). Mean ACL-RSI scores were significantly different among age groups (Pre-Adolescent 80.3±10.6, Adolescent 60.4±23.3, Adult 54.3±21.3; p=0.003) and graft type (HS 61.2±22.0, BTB 52.9±26.4, ITB 82.1±9.7; p=0.019). Scores were significantly different among the 3 age groups for IKDC (Pre-Adolescent 85.4±12.1, Adolescent 77.5±13.8, Adult 61.0±8.4; p<0.001). Scores were not significantly different among the three age groups for Pedi-FABS (Pre-Adolescent 24.9±5.4, Adolescent 23.6±8.1, Adult 20.6±9.2; p=0.212). The mean PROMIS-PSE t-scores were significantly different among the age groups (Pre-Adolescent 45.8±8.6, Adolescent 52.0±7.2, Adult 53.8±8.1; p=0.009) and graft type (HS 52.4±7.7, BTB 52.7±6.6, ITB 40.9±4.9; p<0.001). There were no significant differences for average timing of RTS clearance among the 3 age groups (Pre-Adolescent 8.5±1.5 months, Adolescent 8.0±1.3 months, Adult 8.1±1.2 months; p=0.618). Conclusion: This study suggests that psychological profiles and subjective perceptions of knee function following ACL reconstruction may vary in young patients of different ages. Pre-adolescent patients had better scores on all patient reported outcomes compared to adolescent and adult patients. Age-related differences in patient reported outcomes should be considered when evaluating young athletes. [Figure: see text]

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