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Complications After Pediatric ACL Reconstruction: A Meta-analysis
Stephanie E Wong1, Brian T Feeley, Nirav K Pandya
1Department of Orthopaedic Surgery, University of California, San Francisco, CA.
Insights
Pediatric anterior cruciate ligament (ACL) reconstruction can lead to rerupture and growth disturbances. Prevention of rerupture is crucial, as it often requires revision surgery, while growth disturbances may need corrective procedures.
Area of Science:
- Orthopedic surgery
- Pediatric sports medicine
- Biomechanical engineering
Background:
- Pediatric anterior cruciate ligament (ACL) tears are increasingly common.
- Reconstruction in skeletally immature patients presents unique challenges, including potential growth disturbances.
Purpose of the Study:
- To conduct a meta-analysis of clinical outcomes and complications after pediatric ACL reconstruction.
- To evaluate the incidence of rerupture and growth disturbances in pediatric ACL reconstruction patients.
Main Methods:
- A systematic review of PubMed and EMBASE databases (1985-2016) identified studies on ACL tears in skeletally immature individuals.
- Forty-five studies (1321 patients) reporting on rerupture and/or growth disturbances following ACL reconstruction were included.
- Data on demographics, graft type, surgical technique, follow-up, complications, and patient-reported outcomes were aggregated.
Main Results:
- The meta-analysis included 45 studies with 1321 patients; 8.7% experienced rerupture, often requiring revision surgery.
- Growth disturbances occurred in 7.5% of patients, with 27.6% needing corrective surgery.
- Patient-reported outcomes were generally good, with high International Knee Documentation Committee (IKDC) and Lysholm scores.
Conclusions:
- Growth disturbances are a potential complication of pediatric ACL reconstruction, irrespective of technique.
- Rerupture is a significant concern, necessitating revision surgery at higher rates than growth disturbances.
- Emphasis should be placed on preventing rerupture in pediatric ACL reconstruction, alongside managing growth disturbance risks.
Background:
The purpose of this meta-analysis is to review clinical outcomes and complications following pediatric anterior cruciate ligament (ACL) reconstruction.
Methods:
The PubMed and EMBASE databases were searched for studies on ACL ruptures in the skeletally immature from 1985 to 2016. Full-text studies in English and performed on humans were included (n=5718). Titles included discussed operative intervention on skeletally immature patients with ACL tears (n=160). Studies that reported rerupture and/or complications with ACL reconstruction specific to the pediatric population, specifically growth disturbance, were then included in a secondary analysis (n=45). Complications not specific to the pediatric population were excluded. Demographics, graft type, surgical technique, follow-up, growth disturbance, rerupture, and patient-reported outcome scores were collected. Data were analyzed in aggregate.
Results:
In total, 45 studies were included with 1321 patients and 1392 knees. The average age was 13.0 years, 67% were male, and mean follow-up was 49.6 months. There were 115 (8.7%) reruptures in the initial 160 studies reviewed. In total, 94.6% of patients with rerupture required revision ACL surgery. There were 58 total growth disturbances (16 required corrective surgery, or 27.6%). Eighteen knees (3.7%) developed angular deformity, most commonly valgus. There were 37 patients (7.5%) had at least a 1 cm limb-length discrepancy. A total of 23 studies reported International Knee Documentation Committee scores (range, 81 to 100, 88% grade A or B). In total, 20 studies reported excellent Lysholm scores with mean scores of 94.6.
Conclusions:
Growth disturbance can occur with any of the reconstruction techniques. Proper surgical technique is likely more important than the specific reconstruction technique utilized. Patients with rerupture require surgery at much higher rates than those with growth disturbance. Although much attention has been focused on growth disturbance, we suggest that equal attention be given to the prevention of rerupture in this age group.
Level Of Evidence:
Level III.
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