Maheshwer Bhargavi, Paliobeis Andrew, Halkiadakis Penelope, Konda Sreenivas, Calcei Jacob G, Voos James E
Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; and.
Department of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL.
J Pediatr Orthop. 2023;43(10):591-597. doi: 10.1097/BPO.0000000000002505. Epub 2023 Sep 20.
The incidence of anterior cruciate ligament (ACL) injuries is increasing among the adolescent population with a peak occurring in the high school age range.
To characterize recent epidemiologic trends of ACL injuries, ACL reconstruction (ACLR), and retear rates in high school adolescents based on age, participating sport, and mechanism of injury.
Retrospective case series.
A prospectively maintained institutional database was retrospectively reviewed for all patients 18 or younger who underwent primary ACLR between 2015 and 2020. Odds ratios were calculated for baseline patient characteristics and their association with risk of retear. Multivariate regression analysis was also performed to identify the relationship between retear and specific categorical variables.
A total of 482 patients were included, with a mean follow-up time of 13.0 ± 11.8 months. Patients were an average age of 16.1 ± 1.3 years old (range: 13 to 18 y). Initial presentation of ACL injuries in high school athletes often occurred at 16 years old regardless of the sport played. Based on age, high school freshmen and seniors are found to have an increased risk of ACL retear. One hundred three patients (21.6%) completed at least 2 or more years of follow-up after ACLR. Of these patients, 38.8% received a bone-tendon-bone (BTB) autograft, 36.9% hamstring autograft, 14.6% quadriceps tendon autograft, and 3.9% received hamstring allograft or other graft (eg, tibialis anterior and BTB allograft), respectively. There were 25 ipsilateral ACL retears that occurred in the patient cohort (5.2%). Thirteen (52%) of retears were females. Football and soccer were the most common sports played by patients with a retear of the ipsilateral knee (31.8% and 27.3%, respectively). Patients who were 13 to 14 or 18 years old ( P = 0.009 and 0.035, respectively) or who received a tibialis anterior/BTB allograft ( P = 0.002) were found to have increased risk of ACL retear compared with other age groups. When evaluating by sex, female soccer players had a greater risk of retear compared with male soccer players ( P = 0.007). When adjusting for multiple variables, (including age, sex, body mass index, primary reconstruction graft choice, sport, and length of follow-up), the odds of ipsilateral retear in patients who received hamstring autograft ( P = 0.02), sustained a contralateral ACL tear ( P = 0 .04), or a contact injury ( P = 0.01) were increased.
Initial presentation of ACL injuries in high school athletes often occurs at 16 years old regardless of the sport played. Based on age, high school freshmen and seniors are found to have an increased risk of ACL retear. However, the overall rate of ACL retear in high school athletes of all ages is low. Patients who underwent ACLR with hamstring tendon autograft had a greater risk of retear compared with other graft types. Female soccer players also had a greater risk of ACL retear. High school athletes must take caution when in the early high school years (underclassman) and more senior years (upperclassman), as susceptibility for ACL retears is elevated.
Level IV.
前交叉韧带（ACL）损伤在青少年人群中的发生率正在上升，在高中年龄段达到峰值。
根据年龄、参与的运动项目和损伤机制，描述高中青少年ACL损伤、ACL重建（ACLR）及再撕裂率的近期流行病学趋势。
回顾性病例系列研究。
对一个前瞻性维护的机构数据库进行回顾性分析，纳入2015年至2020年间接受初次ACLR的所有18岁及以下患者。计算基线患者特征及其与再撕裂风险的关联的比值比。还进行了多变量回归分析，以确定再撕裂与特定分类变量之间的关系。
共纳入482例患者，平均随访时间为13.0±11.8个月。患者平均年龄为16.1±1.3岁（范围：13至18岁）。高中运动员ACL损伤的初次表现通常发生在16岁，与所从事的运动项目无关。基于年龄，发现高中新生和高年级学生ACL再撕裂的风险增加。103例患者（21.6%）在ACLR后完成了至少2年或更长时间的随访。在这些患者中，分别有38.8%接受了骨-肌腱-骨（BTB）自体移植物、36.9%接受了腘绳肌自体移植物、14.6%接受了股四头肌肌腱自体移植物，3.9%接受了腘绳肌同种异体移植物或其他移植物（如胫骨前肌和BTB同种异体移植物）。患者队列中发生了25例同侧ACL再撕裂（5.2%）。其中13例（52%）再撕裂患者为女性。足球和英式足球是同侧膝关节再撕裂患者最常参与的运动项目（分别为31.8%和27.3%）。与其他年龄组相比，13至14岁或18岁的患者（分别为P = 0.009和0.035）或接受胫骨前肌/BTB同种异体移植物的患者（P = 0.002）ACL再撕裂的风险增加。按性别评估时，女性足球运动员比男性足球运动员再撕裂的风险更高（P = 0.007）。在对多个变量进行调整后（包括年龄、性别、体重指数、初次重建移植物选择、运动项目和随访时间），接受腘绳肌自体移植物的患者（P = 0.02）、发生对侧ACL撕裂的患者（P = 0.04）或遭受接触性损伤的患者（P = 0.01）同侧再撕裂的几率增加。
高中运动员ACL损伤的初次表现通常发生在16岁，与所从事的运动项目无关。基于年龄，发现高中新生和高年级学生ACL再撕裂的风险增加。然而，所有年龄段的高中运动员ACL再撕裂的总体发生率较低。与其他移植物类型相比，接受腘绳肌肌腱自体移植物进行ACLR的患者再撕裂的风险更高。女性足球运动员ACL再撕裂的风险也更高。高中运动员在高中低年级（低年级学生）和高年级（高年级学生）时必须格外小心，因为ACL再撕裂的易感性会升高。
IV级。
