title: Risk Factors for Early ACL Reconstruction Failure in Pediatric and Adolescent Patients: A Review of 561 Cases.
abstract: BACKGROUND
  Anterior cruciate ligament (ACL) reconstruction failure is relatively common in young high-risk athletes. The purpose of this study was to examine a single center's 10-year experience with ACL reconstructions in pediatric and adolescent patients to better define short-term failure rates and risk factors for revision ACL surgery.
  
  
  METHODS
  This institutional review board-approved retrospective study included all patients who underwent a primary ACL reconstruction between 2002 and 2013. Chart and radiographic review was performed to assess patient demographic, injury, and surgical data including growth plate status, concomitant ligament/meniscus/cartilage injury, surgical procedures, femoral drilling technique, graft source and type, femoral and tibial fixation devices, and graft size. Graft failures had to be confirmed both with clinical examination and magnetic resonance imaging or the patient had to undergo a revision ACL reconstruction. Potential factors associated with failure were evaluated using either parametric or nonparametric analysis as appropriate.
  
  
  RESULTS
  A total of 561 ACL reconstructions were performed that met our inclusion criteria. The average patient age was 15.4 years (range, 5 to 19 y) and 53% of the patients were male. In all, 54 failures were identified for a 9.6% failure rate. Soft tissue grafts were twice as likely to fail compared with patellar tendon grafts (13% vs. 6%; P<0.001). Multivariate analysis revealed that graft choice (soft tissue vs. patellar tendon) was the primary variable predictive of failure (P<0.05), with interactions/mediating effects contributed by maturity (growth plate status) and ACL technique (P<0.05). The average time to failure was 13.6 months and hamstring grafts and anatomic femoral tunnels were both found to fail earlier (P<0.05). During the study period, approximately 8% of patients sustained a contralateral ACL injury.
  
  
  CONCLUSIONS
  ACL failure rates in adolescent and pediatric patients vary based on patient age, graft selection, and surgical technique. Bone patellar tendon bone autografts had the lowest failure rate in this high-risk population.
  
  
  METHODS
  Level IV-retrospective case series.
authors.affiliation: San Diego School of Medicine, University of California.
authors.forename: Brian
authors.initials: B
authors.lastname: Ho
authors.affiliation: San Diego School of Medicine, University of California.|Rady Children's Hospital and Health Center, San Diego, CA.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Edmonds
authors.affiliation: San Diego School of Medicine, University of California.|Rady Children's Hospital and Health Center, San Diego, CA.
authors.forename: Henry G
authors.initials: HG
authors.lastname: Chambers
authors.affiliation: Rady Children's Hospital and Health Center, San Diego, CA.
authors.forename: Tracey P
authors.initials: TP
authors.lastname: Bastrom
authors.affiliation: San Diego School of Medicine, University of California.|Rady Children's Hospital and Health Center, San Diego, CA.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Pennock
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000070598:Anterior Cruciate Ligament Injuries / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods* / Q000706:statistics & numerical data; D001265:Athletic Injuries / Q000601:surgery; D050376:Bone-Patellar Tendon-Bone Grafting / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D055815:Young Adult