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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.