Clinical Outcomes and Return to Sport Rates following Anterior Cruciate Ligament Reconstruction in Skeletally Immature Paediatric Patients Aged 13 Years or Less. Higher Failure to Return to Sport Rates Observed Amongst Female Athletes in our Cohort.

Abstract

The volume of Anterior Cruciate Ligament (ACL) Reconstruction surgery has increased worldwide, however there remains a paucity of information relating to clinical outcomes in skeletally immature paediatric patients aged 13 years or less. Twenty-nine patients aged 13 years or less who underwent ACL reconstruction surgery over a 9-year period at our unit with minimum 2 year follow up were contacted. Data recorded included re-rupture, return to sport and functional outcomes in terms of Internal Knee Documentation Committee and Tegner scores. The mean age at time of reconstruction surgery was 12 years and 9 months, with mean follow up 65.6 months. Twenty-two (76%) patients returned to sport at the same level or higher, at mean 12.9 months post reconstruction, median 12 months. An analysis of those seven patients (24%) who did not return to sport showed a higher failure to return rate amongst female (45%), than male patients (11%), p=0.071. The most common contributory reason cited for failure to return to sport was fear of re-injury which was cited as a factor by each patient who did not return. The mean International Knee Documentation Committee (IKDC) score was 94.4 and Tegner index level of activity declined from mean 8.7 to 7.8. Three patients (10%) experienced an ipsilateral re-rupture post ACL reconstruction. This occurred at mean 56 months (45-63) post reconstruction. One patient (3%) experienced a contralateral ACL rupture. We have shown that satisfactory clinical outcomes are attainable following ACL reconstruction surgery in young skeletally immature patients aged 13 years or less, however ipsilateral re-rupture rates observed up to 10% require advance discussion with patients and caregivers. Variation in return to play rates seen between genders in our sample may be further elucidated in future studies with larger patient numbers. IV.