High satisfaction yet decreased activity 4 years after transphyseal ACL reconstruction

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Pediatric Orthopedics

Background:

• Anterior Cruciate Ligament (ACL) injuries are common in pediatric and adolescent athletes.
• ACL reconstruction is often recommended for athletes aiming to return to high-demand sports.
• Understanding outcomes like reoperation rates and return to sport is crucial for informed decision-making.

Purpose of the Study:

• To evaluate the reinjury rate and need for subsequent surgeries in skeletally immature patients post-ACL reconstruction.
• To assess the correlation between patient satisfaction, functional outcomes, and return to sport.
• To identify factors contributing to the failure to return to preinjury activity levels.

Main Methods:

• Retrospective review of 29 skeletally immature patients undergoing transphyseal ACL reconstruction.
• Follow-up to skeletal maturity and at least 2 years post-surgery, including interviews and examinations.
• Assessment of activity levels (Tegner score), satisfaction (Likert scale), and function (Lysholm score, IKDC grade).

Main Results:

• High reoperation rate: 38% (11/29) required revision or minor operations; 28% (8/29) had contralateral ACL ruptures.
• Despite high average satisfaction (9/10) and function (Lysholm 91/100), only 41% (12/29) returned to their preinjury sport level.
• No correlation found between reoperation/contralateral tears and activity level changes; decreased activity often linked to changing interests with age.

Conclusions:

• Less than 50% of young athletes maintain their preinjury sport level 4 years post-ACL reconstruction, despite high satisfaction and function.
• Patient satisfaction significantly correlates with knee function and return to sport.
• Lifestyle changes and evolving interests with age are primary drivers for decreased activity, not surgical outcomes.