Revision ACL Reconstruction in Adolescent Patients

Area of Science:

• Orthopedic surgery
• Pediatric sports medicine
• Biomedical engineering

Background:

• Pediatric anterior cruciate ligament reconstruction (ACLR) has high failure rates, necessitating revision surgery due to the high activity levels of young patients.
• Understanding trends in revision ACLR for patients under 18 is crucial for optimizing treatment outcomes and surgical techniques.

Purpose of the Study:

• To define trends in revision anterior cruciate ligament reconstruction (ACLR) in patients who underwent initial ACLR at a younger age (under 18 years).
• To analyze surgical techniques, graft choices, and outcomes associated with revision ACLR in the pediatric and adolescent population.

Main Methods:

• Retrospective case series (Level of evidence, 4) of revision ACLR procedures in patients younger than 18 years at initial reconstruction.
• Data collected from electronic medical records between 2010 and 2016, including descriptive information, intraoperative findings, surgical techniques, and rehabilitation.
• Descriptive statistics were used to analyze trends and outcomes.

Main Results:

• Thirty-two patients (mean age 15.8 years at initial reconstruction) underwent revision ACLR.
• Bone-patellar tendon-bone (BTB) autograft was the most common graft for revision (50%), often converting from initial soft tissue grafts.
• Chondral surgery was more frequent during revision (25%) compared to initial reconstruction (0%), and 15.6% experienced contralateral ACL ruptures.

Conclusions:

• Most pediatric patients with anterior cruciate ligament (ACL) graft failure are successfully treated with a single revision surgery, commonly converting to a BTB autograft.
• Staged reconstructions were infrequently required, highlighting the effectiveness of single-stage revision in most cases.
• Clinicians should maintain a high suspicion for associated intra-articular injuries in adolescent patients experiencing ACL graft failure.