Abstract
IntroductionThe guidelines regarding rehabilitation after pediatric anterior cruciate ligament reconstruction (ACLR) are sparse. The aim of the study was to retrospectively describe the long-term outcome regarding further surgery and with special emphasis on the revision rate after two different postoperative rehabilitation programs following pediatric ACLR.Material and methods193 consecutive patients < 15 years of age who had undergone ACLR at two centers, A (n = 116) and B (n = 77), in 2006–2010 were identified. Postoperative rehabilitation protocol at A: a brace locked in 30° of flexion with partial weight bearing for 3 weeks followed by another 3 weeks in the brace with limited range of motion 10°–90° and full weight bearing; return to sports after a minimum of 9 months. B: immediate free range of motion and weight bearing as tolerated; return to sports after a minimum of 6 months.The mean follow-up time was 6.9 (range 5–9) years. The mean age at ACLR was 13.2 years (range 7–14) years.The primary outcome measurement in the statistical analysis was the occurrence of revision. Multivariable logistic regression analysis was performed to investigate five potential risk factors: surgical center, sex, age at ACLR, time from injury to ACLR and graft diameter.ResultsThirty-three percent had further surgery in the operated knee including a revision rate of 12%. Twelve percent underwent ACLR in the contralateral knee. The only significant variable in the statistical analysis according to the multivariable logistic regression analysis was surgical center (p = 0.019). Eight percent of the patients at center A and 19% of the patients at B underwent ACL revision.ConclusionsFurther surgery in the operated knee could be expected in one third of the cases including a revision rate of 12%. The study also disclosed a similar rate of contralateral ACLR at 12%. The revision rate following pediatric ACLR was lower in a center which applied a more restrictive rehabilitation protocol.Level of evidenceCase-control study, Level III.
Highlights
The guidelines regarding rehabilitation after pediatric anterior cruciate ligament reconstruction (ACLR) are sparse
In a long-term followup by Reid et al, a revision rate of 9% was seen in patients younger than 16 years of age at the time of ACLR [24], which is similar to the results in a recent review by Zacharias et al, where graft failures occurred in 8.3% in a skeletally immature patients [25]
The difference was larger than the minimally important change (MIC), which indicates that a re-rupture and the following revision caused a serious impact on the subjective knee function. This was in accordance with the findings in adults by Cristiani et al [37]. In this long-term follow-up study of 193 children after ACLR, we found that the application of more restrictive postoperative management, including the use of a postoperative brace with limited range of motion (ROM), partial weight bearing (WB) and a minimum of 9 months before returning to sports, was related to a significantly lower ACL revision rate
Summary
The guidelines regarding rehabilitation after pediatric anterior cruciate ligament reconstruction (ACLR) are sparse. The aim of the study was to retrospectively describe the long-term outcome regarding further surgery and with special emphasis on the revision rate after two different postoperative rehabilitation programs following pediatric ACLR. The revision rate following pediatric ACLR was lower in a center which applied a more restrictive rehabilitation protocol. Higher participation rates in competitive youth sports, early specialization and increased intensity at young age have been suggested as reasons for the increase in ACL injuries, but the scientific evidence level is low [3]. Females were significantly more vulnerable for an ACL injury and the incidence was in some studies more than twice as high compared with males [5] These large sex differences has not been disclosed regarding graft ruptures and revision rates [6]
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