Age, rehabilitation and surgery characteristics are re-injury risk factors for adolescents following anterior cruciate ligament reconstruction

• Published in: Physical therapy in sport Vol. 49; no. NA; pp. 196 - 203
• Main Authors: Law, Mallory A., Ko, Yi-An, Miller, Ashley L., Lauterbach, Kristin N., Hendley, Christopher L., Johnson, Julie E., Tsai, Liang-Ching
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.05.2021; Elsevier Limited
• Subjects: ACL; Adults; Age; Knee; Medical records; Patients; Pediatrics; Physical therapy; Rehabilitation; Return to sport; Risk factors; Sports injuries; Sports medicine; Surgery; Teenagers; Variables; Atlanta Georgia; United States > US; Knee; Pediatrics; ACL; Return to sport
• ISSN: 1466-853X; 1873-1600; 1873-1600
• DOI: 10.1016/j.ptsp.2021.03.003

To examine the effect of age on post-ACLR rehabilitative outcomes and identify surgical/rehabilitative characteristics as ACL re-injury risk factors in adolescents. Cohort study. Children’s hospital. 273 adolescents with first-time ACLR. Demographics, 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. Re-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). Adolescents 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. •Adolescent patients who are younger had a higher ACL re-injury risk.•However, similar rehabilitative outcomes and progression across all youth patients.•Need sensitive discharge criteria to identity high re-injury risk youth patients.•Getting ACLR or PT sooner or attending less PT also led to a higher re-injury risk.•Structured rehabilitation/PT post-ACLR is critical in preventing ACL re-injury.