Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA.
Baylor Scott & White Orthopaedic Associates of Dallas, Dallas, Texas, USA.
Am J Sports Med. 2019 Mar;47(3):628-639. doi: 10.1177/0363546518819217. Epub 2019 Jan 15.
With sports specialization and level of competition on the rise, anterior cruciate ligament reconstruction (ACLR) in athletes under the age of 20 has increased significantly in recent years. Reports have demonstrated that the revision ACLR rate is higher and return to sport (RTS) rate is lower in this population.
To evaluate the 2-year clinical outcomes of 3 cohorts of primary ACLR in pediatric and adolescent athletes under the age of 20 based on skeletal age with a focus on RTS and the incidence of second surgery.
Case series; Level of evidence, 4.
This is a prospective evaluation of 324 athletes younger than 20 years of age who underwent ACLR with minimum 2-year follow-up. The surgical technique was selected predicated on skeletal age, which includes the all-epiphyseal technique with hamstring autograft in the youngest cohort in elementary and middle school (group 1), the partial transphyseal and complete transphyseal with hamstring autograft performed for athletes in the middle cohort (group 2), and bone-tendon-bone autograft in the skeletally mature high school athletes (group 3).
The mean chronological age of the entire cohort was 15 years (range, 8-19 years) with 55% males. The 3 cohorts included 49 patients (15%) in group 1 (mean age, 12 years), 66 (20%) in group 2 (mean age, 14.3 years), and 209 (65%) in group 3 (mean age, 16.2 years). Group 2 athletes had a significantly higher revision ACLR rate (20%) compared with group 1 (6%; P = .039) and group 3 (6%; P = .001). Similarly, group 2 athletes had significantly lower RTS rates (85%) compared with group 1 (100%) and group 3 (94%).
The rate of revision ACLR was significantly higher and the RTS rates significantly lower in group 2 compared with groups 1 and 3. This age-related risk profile may be used to counsel athletes and parents preoperatively regarding the expectations of surgery with respect to revision ACLR and RTS rates.
随着运动专业化和竞技水平的提高，近年来 20 岁以下运动员前交叉韧带重建（ACLR）的数量显著增加。有报道显示，该人群的 ACLR 翻修率更高，重返运动（RTS）率更低。
评估基于骨骼年龄的 3 组青少年和儿童运动员的初次 ACLR 的 2 年临床结果，重点关注 RTS 和二次手术发生率。
病例系列；证据等级，4 级。
这是一项对 324 名年龄小于 20 岁的 ACLR 患者的前瞻性评估，这些患者均有至少 2 年的随访。手术技术根据骨骼年龄选择，包括在小学和初中的最年轻队列中使用半腱肌自体移植物的全骺技术（第 1 组）、在年龄较大的队列中使用半腱肌自体移植物的部分骺板下和完全骺板下技术（第 2 组）以及在骨骼成熟的高中生中使用骨-腱-骨自体移植物的技术（第 3 组）。
整个队列的平均实际年龄为 15 岁（范围，8-19 岁），男性占 55%。3 个队列包括 49 名（15%）第 1 组患者（平均年龄 12 岁）、66 名（20%）第 2 组患者（平均年龄 14.3 岁）和 209 名（65%）第 3 组患者（平均年龄 16.2 岁）。第 2 组运动员的 ACLR 翻修率（20%）明显高于第 1 组（6%；P =.039）和第 3 组（6%；P =.001）。同样，第 2 组运动员的 RTS 率（85%）明显低于第 1 组（100%）和第 3 组（94%）。
与第 1 组和第 3 组相比，第 2 组的 ACLR 翻修率显著更高，RTS 率显著更低。这种与年龄相关的风险模式可用于术前向运动员及其家长提供关于手术的预期，包括 ACLR 和 RTS 翻修率。
