Outcomes of Anterior Cruciate Ligament Reconstruction Surgery in Pediatric and Adolescent Patients

Background and/or Objectives: Anterior Cruciate Ligament (ACL) tears are common in pediatric and adolescent athletes. Treatment is challenging due to concerns over skeletal immaturity and long-term knee function. This study evaluates long-term outcomes of ACL reconstruction (ACLR) and explores the impact of patient and surgical factors on recovery.

Design: Retrospective Cohort Study

Setting : Pediatric orthopedic clinic in Metro Detroit

Participants : 149 pediatric patients who underwent ACLR between June 1, 2006, and January 1, 2024.

Interventions: Patients who underwent ACLR were identified via retrospective chart review. Demographics, surgical timing, graft type, and outcomes were recorded.

Main Outcome Measures: Incidence and type of postoperative complications, re-operation rate, time from injury to surgery, and follow-up duration.

Results: Among 149 patients (mean age 15), 64% were male and 56.4% were Black/African American. Over half lived in high-deprivation areas according to the Area Deprivation Index, and 57% had public insurance. Concurrent ligamentous or meniscal injuries were found in 32.9% of cases. The average time from injury to surgery was 21 weeks, and mean follow-up was 25.3 months (range: 2.5–152.9 months). The overall complication rate (including Emergency Room visits and hematomas) was 25.5%, with ipsilateral knee injury—primarily ACL re-tear—as most common (p < 0.001). Graft failure occurred in 5.4% of patients. Graft types included hamstring autografts (34.2%), bone-tendon-bone (32.9%), and allografts (30.9%). Statistically significant differences in post-operative complications were found by race (p = 0.036), graft type (p = 0.047), and age (p = 0.045). Time from injury to surgery varied across age groups (p = 0.025). Concurrent repairs differed significantly among sexes (p = 0.034).

Conclusions: High proportions of this cohort were from minority groups and deprived areas. Complication rate (25.5%) appears elevated compared to average ACLR complications in literature (1–10%), while graft failure rate (5.4%) aligns with published data. Significant associations suggest demographics and surgical variables may influence outcomes; full analysis will be presented at AAPM&R.