Department of Orthopedic Surgery, University of California, San Diego, California, USA.
Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, San Diego, California, USA.
Am J Sports Med. 2019 May;47(6):1346-1352. doi: 10.1177/0363546519837173. Epub 2019 Apr 17.
Although primary anterior cruciate ligament (ACL) reconstructions have been well studied in children and adolescents, the literature lacks information about revision ACL reconstructions in this population.
This study aims to analyze the outcomes of revision ACL surgeries in the pediatric population.
Case series; Level of evidence, 4.
A retrospective study was performed on all revision ACL reconstructions performed at a single institution between 2009 and 2017. Patient demographic, injury, and operative data from both the initial surgery and the revision were documented. Outcome measures included the Lysholm score, Single Assessment Numeric Evaluation (SANE) score, Tegner activity score, visual analog scale for pain, Hospital for Special Surgery Pediatric Functional Activity Brief Scale score, patient satisfaction, ability to return to the same level of sport, and any additional injury and/or surgery. Outcomes of the revision surgeries were compared with our institution's outcome database of primary ACL reconstructions.
During the study period, 60 revision ACL reconstructions were performed in 57 patients. Of these patients, 84% (n = 48) were available for a minimum 2-year follow-up and a mean follow-up of 4.4 years. A greater number of meniscal tears and cartilage injuries were documented in the revision cohort. Compared with the primary cohort, the revision cohort had lower SANE scores, Lysholm scores, and satisfaction. Furthermore, the revision cohort had a higher rate of graft failure than the primary cohort (21% vs 9%, respectively; P = .015), and only 27% of revision patients returned to the same level of sport. In a comparison of revision procedures performed with autograft versus allograft tissue, the autograft patients had higher Lysholm scores than the allograft patients (91 vs 83, respectively; P = .045) and trended toward a lower failure rate (11% vs 27%, respectively; P = .199).
Adolescent patients undergoing revision ACL reconstruction had more meniscal and cartilage abnormalities, poorer functional outcomes, and higher graft failure rates than patients undergoing primary ACL reconstructions. Additionally, revision procedures performed with allograft tissue resulted in lower Lysholm scores and a trend toward higher failure rates. When an ACL graft fails in a young patient, strong consideration should be given to using autograft tissue for the revision.
尽管儿童和青少年的初次前交叉韧带（ACL）重建已得到充分研究，但该领域仍缺乏有关此类人群中 ACL 翻修重建的信息。
本研究旨在分析儿童人群中 ACL 翻修手术的结果。
病例系列；证据水平，4 级。
对 2009 年至 2017 年在一家机构进行的所有 ACL 翻修手术进行回顾性研究。记录患者的人口统计学、损伤和初次手术及翻修手术的手术数据。评估结果包括 Lysholm 评分、单项评估数值评分（SANE）、Tegner 活动评分、疼痛视觉模拟评分、特殊外科医院儿童功能活动简要量表评分、患者满意度、重返相同运动水平的能力，以及任何其他损伤和/或手术。将翻修手术的结果与我们机构的初次 ACL 重建结果数据库进行比较。
在研究期间，57 名患者中有 60 名接受了 ACL 翻修手术。其中 84%（n=48）获得了至少 2 年的随访，平均随访时间为 4.4 年。在翻修组中，记录到更多的半月板撕裂和软骨损伤。与初次组相比，翻修组的 SANE 评分、Lysholm 评分和满意度较低。此外，翻修组的移植物失败率高于初次组（分别为 21%和 9%；P=.015），只有 27%的翻修患者能重返相同运动水平。在比较自体移植物与同种异体移植物组织进行的翻修手术时，自体移植物患者的 Lysholm 评分高于同种异体移植物患者（分别为 91 和 83；P=.045），且移植物失败率较低（分别为 11%和 27%；P=.199）。
接受 ACL 翻修重建的青少年患者比初次接受 ACL 重建的患者有更多的半月板和软骨异常，功能结果更差，移植物失败率更高。此外，使用同种异体移植物组织进行的翻修手术会导致 Lysholm 评分较低，且移植物失败率较高的趋势。当年轻患者的 ACL 移植物失效时，应强烈考虑使用自体移植物进行翻修。
