Validated Pediatric Functional Outcomes of All-epiphyseal ACL Reconstructions: Does Reinjury Affect Outcomes?
Adolescent
Anterior Cruciate Ligament Injuries
/ physiopathology
Anterior Cruciate Ligament Reconstruction
/ adverse effects
Athletic Injuries
/ surgery
Child
Female
Growth Plate
/ surgery
Humans
Male
Outcome Assessment, Health Care
/ methods
Postoperative Period
Recovery of Function
Reproducibility of Results
Retrospective Studies
Journal
Journal of pediatric orthopedics
ISSN: 1539-2570
Titre abrégé: J Pediatr Orthop
Pays: United States
ID NLM: 8109053
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
entrez:
6
3
2020
pubmed:
7
3
2020
medline:
12
9
2020
Statut:
ppublish
Résumé
Greater frequency and intensity level of sports participation may be contributing to an increasing incidence of anterior cruciate ligament (ACL) tears in skeletally immature athletes. Prior studies have assessed the functional outcomes of physeal-respecting ACL reconstruction in this patient population based on adult functional outcomes scoring systems; however, there is only sparse literature evaluating functional outcomes of this specific patient population. This study aimed to retrospectively evaluate a cohort of pediatric patients who had undergone all-epiphyseal ACL reconstruction (AEACLR) with a set of clinically validated, pediatric-specific patient-reported functional outcomes scores (PRFOS). We hypothesized that patients who had rerupture would have significantly lower outcomes scores compared with those who did not rerupture. This was a retrospective evaluation of AEACLR patients at a single, tertiary care, children's hospital within a period of 2 years and had >6 months of initial clinical postoperative follow-up. Those who consented to participation were provided an online combined survey including questions relating to demographics and rerupture as well as 3 validated pediatric PRFOS. Statistical analysis of the cohort demographics, PRFOS, and subgroup analysis of the rerupture group compared with the ACL intact patients was performed. The mean functional outcome scores at a mean of 48.6 months from surgery demonstrated excellent return to functional activity (Mean International Knee Documentation Committee, 93.8; Pedi-Patient-Reported Outcomes Measurement Information System, 98.8; Pedi- Functional Activity Brief Score, 21.6). There was a 13% rerupture rate and rerupture patients had a significantly decreased Pedi-International Knee Documentation Committee (94.9 intact vs. 86.0 rerupture; P=0.001) and Pedi-Patient-Reported Outcomes Measurement Information System (99.4 intact vs. 95.4 rupture; P=0.001) scores. AEACLR patients have excellent outcomes based on pediatric-specific PRFOS. Rerupture patients demonstrated a decrease in functional outcomes scores compared with intact ACL patients. The results demonstrate the efficacy of AEACLR as measured by pediatric-specific functional outcome scores for the treatment of ACL rupture in skeletally immature athletes. Level III-retrospective comparative study.
Sections du résumé
BACKGROUND
BACKGROUND
Greater frequency and intensity level of sports participation may be contributing to an increasing incidence of anterior cruciate ligament (ACL) tears in skeletally immature athletes. Prior studies have assessed the functional outcomes of physeal-respecting ACL reconstruction in this patient population based on adult functional outcomes scoring systems; however, there is only sparse literature evaluating functional outcomes of this specific patient population. This study aimed to retrospectively evaluate a cohort of pediatric patients who had undergone all-epiphyseal ACL reconstruction (AEACLR) with a set of clinically validated, pediatric-specific patient-reported functional outcomes scores (PRFOS). We hypothesized that patients who had rerupture would have significantly lower outcomes scores compared with those who did not rerupture.
METHODS
METHODS
This was a retrospective evaluation of AEACLR patients at a single, tertiary care, children's hospital within a period of 2 years and had >6 months of initial clinical postoperative follow-up. Those who consented to participation were provided an online combined survey including questions relating to demographics and rerupture as well as 3 validated pediatric PRFOS. Statistical analysis of the cohort demographics, PRFOS, and subgroup analysis of the rerupture group compared with the ACL intact patients was performed.
RESULTS
RESULTS
The mean functional outcome scores at a mean of 48.6 months from surgery demonstrated excellent return to functional activity (Mean International Knee Documentation Committee, 93.8; Pedi-Patient-Reported Outcomes Measurement Information System, 98.8; Pedi- Functional Activity Brief Score, 21.6). There was a 13% rerupture rate and rerupture patients had a significantly decreased Pedi-International Knee Documentation Committee (94.9 intact vs. 86.0 rerupture; P=0.001) and Pedi-Patient-Reported Outcomes Measurement Information System (99.4 intact vs. 95.4 rupture; P=0.001) scores.
CONCLUSIONS
CONCLUSIONS
AEACLR patients have excellent outcomes based on pediatric-specific PRFOS. Rerupture patients demonstrated a decrease in functional outcomes scores compared with intact ACL patients. The results demonstrate the efficacy of AEACLR as measured by pediatric-specific functional outcome scores for the treatment of ACL rupture in skeletally immature athletes.
LEVEL OF EVIDENCE
METHODS
Level III-retrospective comparative study.
Identifiants
pubmed: 32132445
doi: 10.1097/BPO.0000000000001217
pii: 01241398-202004000-00001
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
157-161Références
Brophy RH, Wright RW, Matava MJ. Cost analysis of converting from single-bundle to double-bundle anterior cruciate ligament reconstruction. Am J Sports Med. 2009;37:683–687.
Mall NA, Chalmers PN, Moric M, et al. Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med. 2014;42:2363–2370.
Mostafavifar AM, Best TM, Myer GD. Early sport specialisation, does it lead to long-term problems? Br J Sports Med [Editorial]. 2013;47:1060–1061.
NCYS report on trends and participation in organized youth sports. 2008. Available at: www.ncys.org/pdfs/2008/2008-ncys-market-research-report.pdf. Accessed August 10, 2016.
Shea KG, Pfeiffer R, Wang JH, et al. Anterior cruciate ligament injury in pediatric and adolescent soccer players: an analysis of insurance data. J Pediatr Orthop. 2004;24:623–628.
Henry J, Chotel F, Chouteau J, et al. Rupture of the anterior cruciate ligament in children: early reconstruction with open physes or delayed reconstruction to skeletal maturity? Knee Surg Sports Traumatol Arthrosc [Comparative Study]. 2009;17:748–755.
Aichroth PM, Patel DV, Zorrilla P. The natural history and treatment of rupture of the anterior cruciate ligament in children and adolescents. A prospective review. J Bone Jt Surg Br Vol. 2002;84:38–41.
Lawrence JT, Argawal N, Ganley TJ. Degeneration of the knee joint in skeletally immature patients with a diagnosis of an anterior cruciate ligament tear: is there harm in delay of treatment? Am J Sports Med. 2011;39:2582–2587.
Fabricant PD, Lakomkin N, Cruz AI, et al. Early ACL reconstruction in children leads to less meniscal and articular cartilage damage when compared with conservative or delayed treatment. J ISAKOS: Jt Disord Orthopaed Sports Med. 2016. Doi: 10.1136/jisakos-2015-000012.
doi: 10.1136/jisakos-2015-000012
Johnston DR, Ganley TJ, Flynn JM, et al. Anterior cruciate ligament injuries in skeletally immature patients. Orthopedics [Review]. 2002;25:864–871; quiz 72–3.
Schachter AK, Rokito AS. ACL injuries in the skeletally immature patient. Orthopedics. 2007;30:365–370; quiz 71–2.
Chotel F, Henry J, Seil R, et al. Growth disturbances without growth arrest after ACL reconstruction in children. Knee Surg Sports Traumatol Arthrosc. 2010;18:1496–1500.
Fabricant PD, Jones KJ, Delos D, et al. Reconstruction of the anterior cruciate ligament in the skeletally immature athlete: a review of current concepts: AAOS exhibit selection. J Bone Jt Surg Am Vol. 2013;95:e28.
Milewski MD, Beck NA, Lawrence JT, et al. Anterior cruciate ligament reconstruction in the young athlete: a treatment algorithm for the skeletally immature. Clin Sports Med. 2011;30:801–810.
Kocher MS, Garg S, Micheli LJ. Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescents. Surg Tech: J Bone Jt Surg Am Vol. 2006;88 (suppl 1pt 2):283–293.
McCarthy MM, Graziano J, Green DW, et al. All-epiphyseal, all-inside anterior cruciate ligament reconstruction technique for skeletally immature patients. Arthrosc Tech. 2012;1:e231–e239.
Anderson AF. Transepiphyseal replacement of the anterior cruciate ligament in skeletally immature patients. A preliminary report. J Bone Jt Surg Am Vol. 2003;85-A:1255–1263.
Lykissas MG, Nathan ST, Wall EJ. All-epiphyseal anterior cruciate ligament reconstruction in skeletally immature patients: a surgical technique using a split tibial tunnel. Arthrosc Tech. 2012;1:e133–e139.
Schmale GA, Kweon C, Larson RV, et al. High satisfaction yet decreased activity 4 years after transphyseal ACL reconstruction. Clin Orthopaed Relat Res. 2014;472:2168–2174.
Kohl S, Stutz C, Decker S, et al. Mid-term results of transphyseal anterior cruciate ligament reconstruction in children and adolescents. Knee. 2014;21:80–85.
Kumar S, Ahearne D, Hunt DM. Transphyseal anterior cruciate ligament reconstruction in the skeletally immature: follow-up to a minimum of sixteen years of age. J Bone Jt Surg Am Vol. 2013;95:e1.
Nawabi DH, Jones KJ, Lurie B, et al. All-inside, physeal-sparing anterior cruciate ligament reconstruction does not significantly compromise the physis in skeletally immature athletes: a postoperative physeal magnetic resonance imaging analysis. Am J Sports Med. 2014;42:2933–2940.
Swami VG, Mabee M, Hui C, et al. MRI anatomy of the tibial ACL attachment and proximal epiphysis in a large population of skeletally immature knees: reference parameters for planning anatomic physeal-sparing ACL reconstruction. Am J Sports Med. 2014;42:1644–1651.
Makani A, Franklin CC, Kanj WW, et al. All-epiphyseal anterior cruciate ligament reconstruction using fluoroscopic imaging. J Pediatr Orthoped Pt B [Case Reports]. 2013;22:445–449.
Lawrence JT, Bowers AL, Belding J, et al. All-epiphyseal anterior cruciate ligament reconstruction in skeletally immature patients. Clin Orthopaed Relat Res [Case Reports]. 2010;468:1971–1977.
Kennedy A, Coughlin DG, Metzger MF, et al. Biomechanical evaluation of pediatric anterior cruciate ligament reconstruction techniques. Am J Sports Med [Research Support, Non-US Govt]. 2011;39:964–971.
Wright RW, Dunn WR, Amendola A, et al. Risk of tearing the intact anterior cruciate ligament in the contralateral knee and rupturing the anterior cruciate ligament graft during the first 2 years after anterior cruciate ligament reconstruction: a prospective MOON cohort study. Am J Sports Med. 2007;35:1131–1134.
Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–381.
Bonnard C, Fournier J, Babusiaux D, et al. Physeal-sparing reconstruction of anterior cruciate ligament tears in children: results of 57 cases using patellar tendon. J Bone Jt Surg Br Vol. 2011;93:542–547.
Guzzanti V, Falciglia F, Stanitski CL. Physeal-sparing intraarticular anterior cruciate ligament reconstruction in preadolescents. Am J Sports Med. 2003;31:949–953.
Nakhostine M, Bollen SR, Cross MJ. Reconstruction of mid-substance anterior cruciate rupture in adolescents with open physes. J Pediatr Orthoped. 1995;15:286–287.
Koch PP, Fucentese SF, Blatter SC. Complications after epiphyseal reconstruction of the anterior cruciate ligament in prepubescent children. Knee Surg Sports Traumatol Arthrosc. 2016;24:2736–2740.
Greenberg EM, Greenberg ET, Ganley TJ, et al. Strength and functional performance recovery after anterior cruciate ligament reconstruction in preadolescent athletes. Sports Health. 2014;6:309–312.
Cruz AI Jr, Fabricant PD, McGraw M, et al. All-epiphyseal ACL reconstruction in children: review of safety and early complications. Arthroscopy. 2016;32:e26.
Pinczewski LA, Lyman J, Salmon LJ, et al. A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med. 2007;35:564–574.
Rauh MJ, Macera CA, Ji M, et al. Subsequent injury patterns in girls’ high school sports. J Athl Train. 2007;42:486–494.
McCarthy MM, Tucker S, Nguyen JT, et al. Contact stress and kinematic analysis of all-epiphyseal and over-the-top pediatric reconstruction techniques for the anterior cruciate ligament. Am J Sports Med. 2013;41:1330–1339.
Kaeding CC, Flanigan D, Donaldson C. Surgical techniques and outcomes after anterior cruciate ligament reconstruction in preadolescent patients. Arthroscopy [Review]. 2010;26:1530–1538.