The Chance to Become an Elite Athlete After Pediatric And Adolescent Anterior Cruciate Ligament Reconstruction

Background: An anterior cruciate ligament (ACL) injury is a severe condition that may affect the career of young athletes. There is limited evidence on the rate and level of return to sport (RTS) after pediatric and adolescent ACL reconstruction. Purpose: To evaluate clinical outcomes, the level and rate of RTS, and predictive factors for RTS after pediatric and adolescent ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Patients aged between 10 and 18 years at the time of primary ACL reconstruction were screened for eligibility. Based on age at the time of ACL reconstruction, patients were divided into the pediatric (female: 11-13 years; male: 11-15 years) and adolescent (female: 14-18 years; male: 16-18 years) groups. Patient-specific, injury-related, and treatment-specific data, as well as subscores of the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline and 1-, 2-, 5-, and 10-year follow-up, were obtained. A survey consisting of 3 patient-specific and 30 knee-related questions was developed by experts in the management of ACL injuries and was sent to all patients to determine sport-specific variables and RTS rates. Results: Overall, 1392 patients (total response rate: 24%) were included in this study. There were 81 pediatric patients (mean age at ACL reconstruction, 13.7 ± 1.4 years) and 1311 adolescent patients (mean age at ACL reconstruction, 16.5 ± 1.2 years). Significant improvements in KOOS subscores were observed after both pediatric and adolescent ACL reconstruction at each follow-up time point. After ACL reconstruction, 74% of pediatric patients and 68% of adolescent patients returned to their previous type of sport ( P = .23). Moreover, 31% of pediatric patients and 23% of adolescent patients became elite athletes (highest national level of junior sport or higher) after ACL reconstruction ( P = .13). A cartilage injury at the time of ACL reconstruction was found to lower the odds of pediatric and adolescent patients returning to their previous type of sport (odds ratio, 0.60; P = .001). A second ACL injury occurred in 25% and 31% of pediatric and adolescent patients, respectively ( P = .29). Conclusion: Long-lasting clinical improvements and high RTS rates can be expected after pediatric and adolescent ACL reconstruction. Moreover, young athletes still have the chance to compete at an elite level of sport after ACL reconstruction.