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Revision ACL Reconstruction in Children and Adolescents

      Introduction

      Results of revision ACL reconstruction in pediatric patients has not been well studied. The purpose of this study was to assess the demographics, technique, and results of ACL revision in children and adolescents.

      Methods

      This was a retrospective case series and outcomes assessment of all pediatric/adolescent patients (<18 years) who underwent revision ACL surgery at a single institution. Charts were reviewed for patient demographics, injury characteristics, operative details, surgical complications, and patient outcome. Patient-oriented outcome measures were also sent to all patients and included the Pedi-IKDC, Tegner Activity Scale, Lysholm Knee Score, and a self-designed Physical Activity Survey to assess return to sport.

      Results

      Ninety revision ACL reconstructions were performed in 88 patients. Average patient age at the time of revision was 16.6 years (SD 1.69), and 28.8% were skeletally immature. Time to failure after primary ACL reconstruction was 1.28 years (SD 1.06), and the most common mechanism of failure was noncontact sports injuries. 74.4% had additional intraarticular injuries that required surgical intervention at the time of revision. Revision graft type included allograft (61.1%), patellar tendon (21.1%), hamstring (16.7%), and iliotibial band (1.1%). There was a 20% graft reinjury rate. Additional procedures after revision were required in 25.5% of knees, and 20% of revision reconstructions had contralateral ACL injuries. 50% of patients completed outcome measures with an average time since revision of 5.1 years. The mean outcome scores were: Pedi-IKDC 71.7 (SD 12.6), Lysholm 79 (SD 13.2), Tegner 6.6 (range 6-10). 69% of patients reported returning to sports at an average of 8.9 months (3-36), however, only 55.2% of these reported being able to return to the same level of play.

      Conclusion

      Revision ACL reconstruction in pediatric patients was associated with worse functional outcome, lower activity level, higher rates of graft retearing, and lower return to sports rates than primary ACL reconstruction.