Secondary Injuries After Pediatric Anterior Cruciate Ligament Reconstruction: A Systematic Review With Quantitative...

Area of Science:

• Orthopedic surgery
• Sports medicine
• Pediatric orthopedics

Background:

• Skeletally immature patients undergoing anterior cruciate ligament (ACL) reconstruction are at increased risk of graft failure and contralateral ACL injury.
• Graft selection and surgical techniques are often influenced by skeletal immaturity.

Purpose of the Study:

• To determine the incidence of ipsilateral graft failure and contralateral ACL injury in skeletally immature patients following ACL reconstruction.

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA guidelines was conducted.
• Literature from May 1976 to May 2019 was reviewed for ACL reconstructions in skeletally immature patients.
• Data on patient demographics, surgical techniques, and secondary injury rates were collected and analyzed, comparing sexes using chi-square tests.

Main Results:

• Analysis of 24 articles involving 1254 children revealed an 8.3% ipsilateral graft failure rate with no significant sex difference.
• Contralateral ACL injury occurred in 22.5% of females versus 8.7% of males (P = .0004).
• Skeletally immature females had a 3.0-fold increased risk of contralateral ACL injury compared to males (P = .0006).

Conclusions:

• Approximately one in three skeletally immature females experience graft failure or contralateral ACL injury.
• The overall 24% secondary injury rate in pediatric ACL reconstruction is similar to that in young skeletally mature adults.
• Enhanced postoperative rehabilitation, activity progression, and return-to-play testing are essential to protect both limbs, especially for female patients.