Anterior Cruciate Ligament Injury—and Repeat Injury

Abstract

Research Article| September 01 2017 Anterior Cruciate Ligament Injury—and Repeat Injury AAP Grand Rounds (2017) 38 (3): 31. https://doi.org/10.1542/gr.38-3-31 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Anterior Cruciate Ligament Injury—and Repeat Injury. AAP Grand Rounds September 2017; 38 (3): 31. https://doi.org/10.1542/gr.38-3-31 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: anterior cruciate ligament injuries, reinjuries, anterior cruciate ligament reconstruction Source: Dekker TJ, Godin JA, Dale KM, et al. Return to sport after pediatric anterior cruciate ligament reconstruction and its effect on subs equent anterior cruciate ligament injury. J Bone Joint Surg Am. 2017; 99(11): 897– 904; doi: https://doi.org/10.2106/JBJS.16.00758Google Scholar Investigators from Duke University conducted a retrospective study to assess the risk of subsequent ACL injury after primary ACL reconstruction surgery in children and adolescents. Eligible study participants were youth <18 years old undergoing primary ACL reconstruction at the authors’ institution between 2006 and 2013 and were identified by using CPT® codes for ACL reconstruction. The medical records of identified patients were reviewed, and demographic data and clinical information were abstracted. Preoperative radiographs of study participants were reviewed, and physeal status (open or closed) was determined. Standardized phone interviews conducted ≥2 years after the index ACL reconstruction were conducted. Data collected during the interview included pre-and postoperative sports participation, time to return to sports, whether a subsequent ACL injury occurred, and time from initial surgery to subsequent injury. Cox regression was used to identify potential risk factors for subsequent ACL injury; risk factors assessed included time to return to sports, return to a high-risk sport (defined as football, basketball, lacrosse, and soccer), physeal status, and type of graft used for index ACL reconstruction. Among 112 eligible patients, complete follow-up data were available for 85 (76%). The mean age of study patients was 13.9 years (range, 6–17 years), and 60% were female. Prior to their initial ACL injury, all study patients participated in sports, with 35% competing in basketball and 28% playing soccer. At the time of surgery, 77% had open physes. After ACL reconstruction, 77 youth (90%) returned to sports. After their primary ACL reconstruction, 27 study participants (32%) sustained a second ACL injury, including 16 patients who injured the ipsilateral ACL and 11 who injured the contralateral side; 1 youth had a tear on both sides. Among the risk factors for subsequent ACL injury assessed in multivariate analyses, only an increased time to return to sports was associated with a decreased risk of a second ACL injury after the initial ACL reconstruction (hazard ratio per month of additional delay in returning to sports = 0.87, P = .04). For youth who had a second ACL tear, mean time from index surgery until return to sports was 8.9 months ± 2.5, compared to 9.9 months ± 3.4 for those who had not experienced a second injury at the time of follow-up. The authors conclude that among youth undergoing ACL reconstruction, there is a substantial risk of a second ACL injury. Dr Hennrikus has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. ACL reconstruction is increasingly common in children. The increasing prevalence of ACL injuries is thought to be due to year-round youth sports participation and early sport specialization.1 Nonsurgical treatment of... You do not currently have access to this content.