According to a study, a higher rate of revision ACL reconstruction and lower return-to-sport rates were experienced by adolescent athletes, compared with prepubescent athletes and skeletally mature athletes.
“We concluded that this is the first report to clearly demonstrate that younger athletes who have had an all-epiphyseal reconstruction with a hamstring autograft had better outcomes than older adolescents who had a hamstring autograft who again were not skeletally mature” (source)
Frank A. Cordasco, MD, professor of orthopedic surgery at Weill Cornell Medical College and attending orthopedic surgeon in the sports medicine and shoulder service at Hospital for Special Surgery.
Revision rates of ACL Reconstruction
324 athletes younger than 20 years of age who underwent ACL reconstruction were categorized into three groups:
- Prepubescent athletes with 3 to 6 years of growth remaining – Group 1
- Young adolescents with 2 to 3 years of growth remaining – Group 2
- Skeletally mature athletes who were typically in high school or college – Group 3
Researchers selected the surgical technique based on skeletal age:
- All-epiphyseal technique with hamstring autograft in Group 1;
- Partial transphyseal and complete transphyseal with hamstring autograft in Group 2;
- Bone-tendon-bone autograft in Group 3.
All of the athletes participated in travel, club or school levels of competition and 75% participated in soccer, lacrosse, basketball or football.
“When we looked at revision rates, the revision ACL reconstruction rate in group 1 was 6% and in group 3 was 6%, and those are favorable compared to the revision rates reported in the literature” Cordasco said.
Patients in group 2 experienced a failure rate of 20%. This may be caused by multiple factors, including the transition into a higher level of competition and use of hamstring autografts.
“Hamstring autografts in general in … recreational adults seem to be a reasonable graft, but in this high-risk level of competition, these youngsters seem to be particularly at risk” Cordasco said.
Return to Sport after ACL Reconstruction
Return to sport means playing a full season in the same sport that the athlete was injured in:
- Group 1 | 100%
- Group 2 | 85%
- Group 3 | 94%
Return to sport rate playing a full season at the same level as the athlete was before injury:
- Group 1 | 92%
- Group 2 | 74%
- Group 3 | 80%
Multivariate logistic regression showed athletes in group 2 had a four-times rate of failure as it related to revision Anterior Cruciate Ligament reconstruction compared with group 3.
“When we did the same multivariate logistic regression regarding contralateral ACL reconstruction, we found a 2.8 odds ratio for … females compared to males and that was statistically significant” Cordasco said.
The rate of revision ACL reconstruction was significantly higher and the return to sport rates significantly lower in group 2 compared with groups 1 and 3.
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