Lind Dane R G, Sabatino Meagan J, Clark Virginia C, Van Pelt Robert L, Vandenberg Curtis D, Beck Jennifer J, Pennock Andrew T, Cruz Aristides I, Ganley Theodore J, Shea Kevin G, Wilson Philip L, Ellis Henry B
Steadman Philippon Research Institute, Vail, CO, USA.
UMass Chan Medical School, Worcester, MA, USA.
J Pediatr Soc North Am. 2025 Mar 18;11:100178. doi: 10.1016/j.jposna.2025.100178. eCollection 2025 May.
Pediatric anterior cruciate ligament reconstructions (ACLR) have increased dramatically in recent years. However, a comprehensive list of short-term complications related to this procedure has yet to be reported. This study aimed to report complication rates in pediatric ACLR using submissions to the American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination. A secondary goal was to assess the relationship of complications with patient sex, geographic region of surgery, surgical volume, and surgeon fellowship training.
A query was submitted to the ABOS Part II Oral Examination Case List Database for all ACLR performed in patients younger than 19 years between 2000 and 2021. Surgeon fellowship training, geographic region of surgery, and patient demographics were included, along with medical, surgical, and anesthetic complications, reoperation, and readmission. Statistic comparisons used chi-square tests for categorical variables with significance set at < 0.05.
Surgical complications were the most common type of complication, present in 10.1% of pediatric ACLR. Stiffness (3.6%) and infection (1.5%) were the most prevalent surgical complications. Females had higher rates of overall complications than males (11.9% vs. 10.4%, = 0.010). Females also had higher rates of surgical complications (10.7%-9.5%, = 0.019) -- specifically stiffness (5.0%-2.2%, < 0.001). However, males had higher rates of infection (1.8% vs. 1.3%, = 0.047). Geographic analyses showed higher infection rates in Hawaii and Alaska and lower surgical complication rates in the Northwest region. Procedures completed by surgeons with a fellowship training other than Sports Medicine and/or Pediatric Orthopaedics had lower rates of overall complications (8.9%, < 0.001) and surgical complications (8.3%, < 0.001).
This study establishes that female pediatric and adolescent patients are at an increased risk for complications following ACLR. Arthrofibrosis was more than twice as common in females than in males. Geographic region and fellowship training may be associated with complications in this population.
Cross-Sectional Study.
(1)Complications following ACL reconstruction may be associated with geographic region and fellowship training.(2)Females present with more short-term complications following ACL reconstruction.(3)There was a higher reported infection rate overall for surgeons in their board collection period than infection rates in the literature, with males having an overall higher infection rate than females.(4)Arthrofibrosis is more than twice as common in females than males following ACL reconstruction.
III.
近年来，儿童前交叉韧带重建术（ACLR）的数量急剧增加。然而，尚未有关于该手术相关短期并发症的综合列表报告。本研究旨在通过美国骨科医师协会（ABOS）第二部分口试提交的病例报告儿童ACLR的并发症发生率。第二个目标是评估并发症与患者性别、手术地区、手术量和外科医生专科培训之间的关系。
向ABOS第二部分口试病例列表数据库查询2000年至2021年间对19岁以下患者进行的所有ACLR。纳入外科医生专科培训、手术地区和患者人口统计学信息，以及医疗、手术和麻醉并发症、再次手术和再次入院情况。统计比较使用卡方检验对分类变量进行分析，显著性设定为<0.05。
手术并发症是最常见的并发症类型，在儿童ACLR中占10.1%。僵硬（3.6%）和感染（1.5%）是最常见的手术并发症。女性的总体并发症发生率高于男性（11.9%对10.4%，=0.010）。女性的手术并发症发生率也更高（10.7%对9.5%，=0.019）——特别是僵硬（5.0%对2.2%，<0.001）。然而，男性的感染发生率更高（1.8%对1.3%，=0.047）。地理分析显示，夏威夷和阿拉斯加的感染率较高，而西北地区的手术并发症发生率较低。由非运动医学和/或小儿骨科专科培训的外科医生完成的手术总体并发症发生率较低（8.9%，<0.001），手术并发症发生率也较低（8.3%，<0.001）。
本研究表明，儿童和青少年女性患者在ACLR后发生并发症的风险增加。关节纤维化在女性中比男性中常见两倍多。地理区域和专科培训可能与该人群的并发症有关。
横断面研究。
（1）ACLR后的并发症可能与地理区域和专科培训有关。（2）女性在ACLR后出现更多短期并发症。（3）在委员会收集期间，外科医生报告的总体感染率高于文献中的感染率，男性的总体感染率高于女性。（4）ACLR后关节纤维化在女性中比男性中常见两倍多。
III级。
