Prospective Methodology Results in Higher Rates of Reported Complications Following Pediatric ACL Reconstruction

The incidence of pediatric anterior cruciate ligament reconstructions (ACLR) has drastically increased over the last 20 years. Previous studies have sought to characterize postoperative complications, but few have utilized a prospective, surgeon-reported protocol. This study aimed to utilize a large, multicenter, prospective collection from a quality improvement registry to determine complication incidence ≤8 months after ACLR. Additional aims sought to compare complication rates between the prospective database and a non-prospective database, as well as between early-career (≤5 y) and more experienced surgeons (>5 y).

This study is a review of complication rates after pediatric ACLR submitted to 2 different collection instruments: the Sports Cohort Outcomes Registry (SCORE), a multicenter, prospective quality improvement registry, and the American Board of Orthopaedic Surgeons (ABOS) Part II Oral Exam database. Patients within the SCORE database underwent surgery from 2018 to 2025 and were ≤18 years old at the time of surgery, while ABOS patients underwent surgery from 2000 to 2021 and were ≤19 years old. Frequencies of complications were calculated, and statistical analysis followed using χ 2 and Fisher's exact tests. Additional comparisons were performed based on surgeon experience. Significance was set at P <0.05.

Out of 8516 total cases in the SCORE database, 992 (11.6%) experienced a complication ≤8 months post-operation, and there was no significant difference between SCORE and ABOS incidence of total complications (11.6% vs. 11.1%, P =0.2296) (SCORE % vs. ABOS %, P value). In addition, there were no differences in medical complications (0.8% vs. 0.9%, P =0.2182), surgical complications (10.8% vs. 10.1%, P =0.0777), and infection (1.3% vs. 1.5%, P =0.2023). The most common complication, stiffness, had significant differences in reported rates between SCORE and ABOS (4.8% vs. 3.6%, P =0.0013). Differences were also noted in reoperation (3.7% vs. 1.8%, P <0.0001), wound-healing delay (1.3% vs. 0.5%, P <0.0001), pain (1.2% vs. 0.4%, P <0.0001), nerve palsy (1.0% vs. 0.7%, P =0.0325), readmission (0.6% vs. 1%, P =0.0047), and deep vein thrombosis (0.1% vs. 0.2%, P =0.0119). Further analysis of SCORE surgeons with >5 years of experience versus SCORE surgeons with ≤5 years of experience yielded no differences among any complications. In addition, significant differences were no longer found for only DVT (0% vs. 0.2%, P =0.6247) and nerve palsy (0.3% vs. 0.7%, P =0.3281) when comparing SCORE surgeons with ≤5 years of experience versus ABOS surgeons.

This study provides the first comprehensive list of complications after pediatric ACLR with a large, entirely pediatric, and prospective patient cohort. In addition, it provides the first statistical comparison between pediatric ACLR complications as reported by a prospective database versus a non-prospective database and finds that prospective studies may allow for more accurate determination of reoperation rates and surgical-related complication rates, such as pain, stiffness, and wound-healing delay. In addition, this study provides evidence that complication rates after ACLR do not differ between early-career (≤5 y) and more experienced (>5 y) surgeons.