Age,rehabilitation and surgery characteristics are re-injury risk factors for adolescents following anterior cruciate ligament reconstruction |
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| Affiliation: | 1. Department of Physical Therapy, Georgia State University, Atlanta, GA, USA;2. Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA;3. Sovereign Rehabilitation, Atlanta, GA, USA;4. Children’s Healthcare of Atlanta, Atlanta, GA, USA;1. Department of Orthopaedic Surgery, KonKuk University Medical Center, Seoul, Republic of Korea;2. Department of Radiology, KonKuk University Medical Center, Seoul, Republic of Korea;3. Sports Medical Center, KonKuk University Medical Center, Seoul, Republic of Korea;4. Department of Orthopaedic Surgery, Cham TnTn Hospital, Seoul, Republic of Korea;5. Department of Orthopaedic Surgery, HanYang University Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea;1. Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, USA;2. Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA;1. Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A.;2. Amsterdam UMC, University of Amsterdam Department of Orthopaedic Surgery, Amsterdam, The Netherlands;1. Connecticut Children''s, Sports Physical Therapy, Farmington, CT, United States;2. Doctor of Physical Therapy Program, Tufts University School of Medicine, Boston, MA, United States;1. Texas Health Sports Medicine, 800 5th Ave. Suite 150, Fort Worth, TX, 76104, USA;2. Fort Worth Orthopedics, 800 5th Ave. Suite 200, Fort Worth, TX, 76104, USA;3. Texas Woman’s University 5500 Southwestern Medical Avenue, Dallas, TX, 75235, USA;4. Orthopedic Specialty Associates. 800 5th Ave. Suite 300, Fort Worth, TX, 76104, USA;5. Sideline Orthopedics and Sport, 902 West Randol Mill Rd Suite 120, Arlington, TX, 76012, USA;1. The Micheli Center for Sports Injury Prevention, Waltham, MA, USA;2. Division of Sports Medicine, Department of Orthopaedics, Boston Children’s Hospital, Boston, MA, USA;3. Faculty of Sport Sciences, Waseda University, Tokyo, Japan;4. Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA |
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| Abstract: | ObjectivesTo examine the effect of age on post-ACLR rehabilitative outcomes and identify surgical/rehabilitative characteristics as ACL re-injury risk factors in adolescents.DesignCohort study.SettingChildren’s hospital.Participants273 adolescents with first-time ACLR.Main outcome measuresDemographics, injury history, surgery, and outcomes documented during post-ACLR physical therapy (PT) sessions were extracted from medical records. Effects of age on outcomes were examined using multivariate regression. ACL re-injury risk factors were identified using survival analysis with Cox regression.ResultsRe-injury was recorded in 47 patients (17.2%) with a median follow-up time of 3.1 years and median re-injury time of 13.4 months post-surgery. Younger age (Hazard-Ratio, HR = 1.264 per year decrease; P = 0.005), receiving surgery within 1 month post-injury (HR = 3.378 vs. >3 months; P = 0.012), starting PT within 3 days post-surgery (HR = 3.068; P = 0.022), and decreased number of PT sessions (HR = 1.118 per 3-session decrease; P = 0.010) increased re-injury risk. Although age was associated with re-injury risk, age was not associated with any outcome (P > 0.059).ConclusionAdolescents who are younger, receive surgery and post-surgery PT sooner, or attend fewer PT sessions may be at an increased re-injury risk. Younger patients achieved similar outcomes despite elevated re-injury risk. Current discharge criteria are inadequate in identifying high re-injury risk patients. |
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| Keywords: | ACL Knee Pediatrics Return to sport |
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