Department of Sports Traumatology, Aarhus University Hospital, Aarhus, Denmark.
Orthop J Sports Med. 2014 Oct 8;2(10):2325967114552405. doi: 10.1177/2325967114552405. eCollection 2014 Oct.
The number of children and adolescents with anterior cruciate ligament (ACL) reconstructions is increasing, and disturbing reports on high rerupture rates in this group have been noted.
To describe the outcome of ACL reconstruction in children and adolescents based on data from the Danish Knee Ligament Reconstruction Registry (DKRR).
Cohort study; Level of evidence, 3.
Data were retrieved from the DKRR, a national population-based registry. The analysis was based on a population of 14,806 ACL-reconstructed patients. The outcome was evaluated using risk of ACL revision, subjective outcome score (Knee injury and Osteoarthritis Outcome Score [KOOS]), Tegner function score, and objective knee laxity. Three age groups were defined (A, <13 years; B, 13-15 years; and C, 15-20 years) and compared with D, patients ≥20 years (adults). There were 95 patients in group A, 327 in B, 2888 in C, and 11,496 in D.
There was a significantly increased risk of revision surgery in the age groups B (6.7%) and C (4.9%) compared with the adults in group D (2.0%). Objective knee laxity did not differ between the 4 groups. Groups A, B, and C had a higher score on the combined KOOS symptoms, pain, sport, and quality of life subscales (KOOS4; 79.6, 76.6, and 73.1, respectively) compared with the adults (69.7). Group B had higher KOOS quality of life (76.6) and sports (71.1) scores than did group C (73.1 and 66.4, respectively). The Tegner activity score did not differ between the 4 groups. No impact of the use of extracortical graft fixation was detected in the youngest age group.
Study results indicated an increased risk of graft failure in patients between 13 and 20 years of age. This is in contrast to the better subjective and equal objective knee score found in the same age groups.
The new knowledge about the high revision rate among ACL-reconstructed teenagers is important for evidence-based preoperative information of ACL patients and their parents.
接受前交叉韧带（ACL）重建的儿童和青少年人数不断增加，并且已经注意到该人群中存在较高的再撕裂率的令人不安的报道。
根据丹麦膝关节韧带重建登记处（DKRR）的数据，描述儿童和青少年 ACL 重建的结果。
队列研究；证据水平，3 级。
从基于人群的国家登记处 DKRR 中检索数据。该分析基于 14806 例 ACL 重建患者的人群。使用 ACL 翻修风险、主观结局评分（膝关节损伤和骨关节炎结局评分[KOOS]）、Tegner 功能评分和客观膝关节松弛度来评估结局。定义了 3 个年龄组（A，<13 岁；B，13-15 岁；C，15-20 岁），并与 D 组（≥20 岁的患者）进行比较。A 组有 95 例患者，B 组有 327 例患者，C 组有 2888 例患者，D 组有 11496 例患者。
与 D 组（成人）相比，B 组（6.7%）和 C 组（4.9%）的翻修手术风险显著增加。4 组之间的客观膝关节松弛度没有差异。A、B 和 C 组在 KOOS 综合症状、疼痛、运动和生活质量亚量表（KOOS4）的评分均高于成人（分别为 79.6、76.6 和 73.1）。B 组在 KOOS 生活质量（76.6）和运动（71.1）评分方面优于 C 组（分别为 73.1 和 66.4）。4 组之间的 Tegner 活动评分无差异。在年龄最小的组中未发现皮质外移植物固定的使用有影响。
研究结果表明，13 至 20 岁患者移植物失败的风险增加。这与同一年龄组中发现的更好的主观和相等的客观膝关节评分形成对比。
关于 ACL 重建青少年中高翻修率的新知识，对于 ACL 患者及其父母的基于证据的术前信息很重要。
