title: Fifteen-Year Survival of Endoscopic Anterior Cruciate Ligament Reconstruction in Patients Aged 18 Years and Younger.
abstract: BACKGROUND
  The current body of literature surrounding anterior cruciate ligament (ACL) survival and the variables contributing to further ACL injuries after primary ACL reconstruction in children and adolescents is limited, with no long-term evidence examining the incidence and contributing factors of further ACL injuries in this younger patient population.
  
  
  OBJECTIVE
  To determine the long-term survival of the ACL graft and the contralateral ACL (CACL) after primary reconstruction in patients aged ≤18 years and to identify the factors that increase the odds of subsequent ACL injuries.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Patients having undergone primary ACL reconstruction at age ≤18 years between 1993 and 1998 who were included in a prospective database by a single surgeon were considered for this study. Single-incision endoscopic ACL reconstruction was performed with either an autologous bone-patellar tendon-bone graft or a hamstring tendon graft. At a minimum of 15 years after ACL reconstruction, patients completed a subjective survey involving the International Knee Documentation Committee (IKDC) questionnaire in addition to questions regarding current symptoms, further ACL injuries, family history of ACL injury, and current level of activity.
  
  
  RESULTS
  A total of 288 adolescents (age range, 13-18 years) met the inclusion criteria, of whom 242 (84%) were reviewed at a mean of 16 years and 6 months after ACL reconstruction. Of these patients, 75 (31%) sustained a further ACL injury: 27 (11.2%) suffered an ACL graft rupture, 33 suffered a CACL injury (13.6%), and 15 sustained both an ACL graft rupture and a CACL injury (6.2%) over 15 years. Survival of the ACL graft was 95%, 92%, 88%, 85%, and 83% at 1, 2, 5, 10, and 15 years, respectively, and survival of the CACL was 99%, 98%, 90%, 83%, and 81%, respectively. Survival of the ACL graft was less favorable in those with a family history of ACL injury than in those without a family history (69% vs 90%, respectively; hazard ratio [HR], 3.6; P = .001). Survival of the CACL was less favorable in male patients than in female patients (75% vs 88%, respectively; HR, 2.1; P = .03) and in those who returned to competitive team ball sports than in those who did not (78% vs 89%, respectively; HR, 2.3; P = .05).
  
  
  CONCLUSIONS
  After ACL reconstruction in patients aged ≤18 years, a further ACL injury occurred in 1 in 3 patients over 15 years. The 15-year survival rate of the ACL graft was 83%, and the 15-year survival rate of the CACL was 81%. The ACL graft and CACL were most vulnerable within the first 5 years after index surgery. A family history of ACL rupture significantly increased the risk for ACL graft ruptures, and a CACL injury was more common in male patients and those who returned to team ball sports. High IKDC scores and continued participation in sports were maintained over the long term after ACL reconstruction in the adolescent population.
authors.affiliation: University of Notre Dame Australia, Fremantle, Australia.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Morgan
authors.affiliation: North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia lsalmon@nsosmc.com.au.
authors.forename: Lucy J
authors.initials: LJ
authors.lastname: Salmon
authors.affiliation: North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Waller
authors.affiliation: North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia.
authors.forename: Justin P
authors.initials: JP
authors.lastname: Roe
authors.affiliation: University of Notre Dame Australia, Fremantle, Australia North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia.
authors.forename: Leo A
authors.initials: LA
authors.lastname: Pinczewski
mesh_terms: D000293:Adolescent; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction; D001182:Arthroscopy / Q000401:mortality*; D064594:Bone-Patellar Tendon-Bone Grafts / Q000706:statistics & numerical data; D016022:Case-Control Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007718:Knee Injuries / Q000401:mortality / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012421:Rupture / Q000601:surgery; D013177:Sports / Q000706:statistics & numerical data; D013710:Tendons / Q000637:transplantation
keywords: ACL reconstruction; adolescent; contralateral ACL; graft rupture; juvenile; long term; survivorship