Return to Sport and Reoperation Rates in Patients Under the Age of 20 After Primary Anterior Cruciate Ligament Reconstruction: Risk Profile Comparing 3 Patient Groups Predicated Upon Skeletal Age
Return to Sport and Reoperation Rates in Patients Under the Age of 20 After Primary Anterior Cruciate Ligament Reconstruction: Risk Profile Comparing 3 Patient Groups Predicated Upon Skeletal Age
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DOI：
10.1177/0363546518819217
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发表时间：
2019-03-01
影响因子：
4.8
通讯作者：
Green, Daniel W.
中科院分区：
文献类型：
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作者：
Cordasco, Frank A.;Black, Sheena R.;Green, Daniel W.
背景：随着体育运动专业化和竞技水平的提高，20岁以下运动员的前交叉韧带重建（ACLR）近年来显著增加。报告显示，在这一人群中，修正ACLR率较高，而重返运动（RTS）率较低。目的：基于骨骼年龄评估3组20岁以下儿童和青少年运动员原发性ACLR的2年临床结果，重点关注RTS和第二次手术发生率。研究设计：病例系列；证据等级，4级。方法：这是一项对324名年龄小于20岁的运动员进行ACLR的前瞻性评估，随访至少2年。根据骨骼年龄选择手术技术，其中小学和初中年龄最小的队列采用全骨骺技术联合腘绳肌腱自体移植（1组），中等队列运动员采用部分经骨骺和完全经骨骺联合腘绳肌腱自体移植（2组），骨骼成熟的高中运动员采用骨-肌腱-骨自体移植（3组）。结果：整个队列的平均实足年龄为15岁（范围8-19岁），其中55%为男性。3个队列包括1组49例（15%）患者（平均年龄12岁），2组66例（20%）患者（平均年龄14.3岁），3组209例（65%）患者（平均年龄16.2岁）。2组运动员的修正ACLR率（20%）明显高于1组（6%,P = 0.039）和3组（6%,P = .001）。同样，2组运动员的RTS率（85%）明显低于1组（100%）和3组（94%）。结论：与1、3组相比，2组ACLR改版率显著增高，RTS改版率显著降低。这种与年龄相关的风险概况可用于术前就手术对ACLR和RTS修正率的期望向运动员和家长提供咨询。
Background: With sports specialization and level of competition on the rise, anterior cruciate ligament reconstruction (ACLR) in athletes under the age of 20 has increased significantly in recent years. Reports have demonstrated that the revision ACLR rate is higher and return to sport (RTS) rate is lower in this population. Purpose: To evaluate the 2-year clinical outcomes of 3 cohorts of primary ACLR in pediatric and adolescent athletes under the age of 20 based on skeletal age with a focus on RTS and the incidence of second surgery. Study Design: Case series; Level of evidence, 4. Methods: This is a prospective evaluation of 324 athletes younger than 20 years of age who underwent ACLR with minimum 2-year follow-up. The surgical technique was selected predicated on skeletal age, which includes the all-epiphyseal technique with hamstring autograft in the youngest cohort in elementary and middle school (group 1), the partial transphyseal and complete transphyseal with hamstring autograft performed for athletes in the middle cohort (group 2), and bone-tendon-bone autograft in the skeletally mature high school athletes (group 3). Results: The mean chronological age of the entire cohort was 15 years (range, 8-19 years) with 55% males. The 3 cohorts included 49 patients (15%) in group 1 (mean age, 12 years), 66 (20%) in group 2 (mean age, 14.3 years), and 209 (65%) in group 3 (mean age, 16.2 years). Group 2 athletes had a significantly higher revision ACLR rate (20%) compared with group 1 (6%; P = .039) and group 3 (6%; P = .001). Similarly, group 2 athletes had significantly lower RTS rates (85%) compared with group 1 (100%) and group 3 (94%). Conclusion: The rate of revision ACLR was significantly higher and the RTS rates significantly lower in group 2 compared with groups 1 and 3. This age-related risk profile may be used to counsel athletes and parents preoperatively regarding the expectations of surgery with respect to revision ACLR and RTS rates.