Long-term Clinical and Radiographic Results After Delayed Anterior Cruciate Ligament Reconstruction in Adolescents

Abstract

Background: The risk of further intra-articular damage associated with nonoperative or delayed anterior cruciate ligament (ACL) reconstruction must be considered against the risk of growth disturbance with early reconstruction and transphyseal drilling. Long-term follow-ups after the surgical treatment of ACL injuries in adolescents are rare. Purpose: To evaluate results 10 to 20 years after ACL reconstruction in terms of the radiographic presence of osteoarthritis, clinical assessments, and health-related quality of life in patients who were adolescents at the time of surgery. Study Design: Case series; Level of evidence, 4. Methods: Thirty-two adolescents (mean age, 15.2 years [range, 12-16 years]; 11 boys, 21 girls), with a symptomatic unilateral ACL rupture, underwent reconstruction using bone–patellar tendon–bone (n = 10) or hamstring tendon (n = 22) autografts at an almost skeletally mature age according to Tanner stage 4. Twenty-nine patients (91%) underwent clinical, radiographic, and health-related quality of life assessments after 10 to 20 years (mean, 175 months). Results: The mean time between the injury and index surgery was 11.6 months. The reconstructed knee had significantly more osteoarthritic changes compared with the noninvolved contralateral knee ( P = .001). Preoperatively, the median Tegner activity level was 4 (range, 2-8), and the median Lysholm knee score was 75 (range, 50-90) points. At follow-up, the respective median values were 4 (range, 1-7) and 84 (range, 34-100) points ( P = not significant [preoperatively vs follow-up]). The median finding for the single-legged hop test was 84% (range, 0%-105%) preoperatively and 93% (range, 53%-126%) at follow-up ( P = .01). At follow-up, muscle strength measurements displayed more than 90% of the noninvolved leg in both extension and flexion. The manual Lachman test result was significantly improved at follow-up compared with preoperatively ( P < .001). The 36-item Short Form Health Survey (SF-36) revealed scores comparable with those of healthy controls. The mean EuroQol (EQ-5D) score was 0.86 ± 0.12. The Knee injury and Osteoarthritis Outcome Score (KOOS) values were lower in all dimensions compared with age-matched healthy controls. Conclusion: In the long term, patients who were adolescents at the time of ACL reconstruction revealed significantly more radiographically visible osteoarthritic changes in their operated knee than in their noninvolved contralateral knee. Clinical outcomes and health-related quality of life are comparable with those of healthy controls.