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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Return to Sport and Re-Operation Rates in Athletes Under the Age of 20 Following Primary Anterior Cruciate Ligament Reconstruction: Risk Profile Comparing Three Patient Groups Predicated Upon Skeletal Age
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Return to Sport and Re-Operation Rates in Athletes Under the Age of 20 Following Primary Anterior Cruciate Ligament Reconstruction: Risk Profile Comparing Three Patient Groups Predicated Upon Skeletal Age

机译：原位前交叉韧带重建后20岁以下运动员的运动恢复率和再手术率：比较根据骨骼年龄确定的三组患者的风险概况

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Objectives: ACL injury in the skeletally immature athlete has become an increasingly significant clinical problem in recent years. The high-risk population of athletes less than 20 years of age has the lowest return to sport (RTS) rates and highest second surgery rates following ACL reconstruction (ACLR). The purpose of this prospective study is to evaluate the two-year clinical outcomes of three groups of primary ACLR in pediatric and adolescent athletes under the age of 20 based on skeletal age, school grade distribution and ACLR technique with a focus on RTS and incidence of second surgery. We hypothesize that the youngest (Group 1) and oldest (Group 3) cohorts will have lower revision ACL rates and higher RTS rates compared to the middle (Group 2) cohort of athletes. Methods: 306 patients less than 20 years of age underwent primary ACLR in the senior authors’ practice. Group 1 had 3-6 years of growth remaining and was comprised of lower and middle school athletes through 7th grade. Group 1 athletes received an all-epiphyseal (AE) hamstring autograft ACLR. Group 2 had 2-3 years of growth remaining and included predominantly 8th and 9th grade athletes. Group 2 was treated with either a partial transphyseal (PTP) or complete transphyseal (CT) hamstring autograft ACLR. Group 3 included skeletally mature high school & collegiate athletes treated with a CT ACLR using a bone-tendon-bone (BTB) autograft. Preoperative demographics, sport, mechanism of injury, intraoperative findings, RTS and second surgery data were collected. Athletes were followed for a minimum of 24 months with serial clinic visits. Results: The three cohorts included 47 athletes (15%) in Group 1 (mean age: 12.0 + 1.5y), 64 athletes (21%) in Group 2 (mean age: 14.3 + 1.3y), and 195 athletes (64%) in Group 3 (mean age: 16.2 + 1.8y). The rate of revision ACL was higher in Group 2 at 20% (13/64 athletes) as compared to Group 1 at 6% (3/47 athletes) and Group 3 at 6% (11/195 athletes) (p= 0.001). Group 2 athletes had a significantly lower RTS at 86% as compared to Groups 1 and 3 at 100% and 94% respectively (p=0.009). Group 2 athletes also had a significantly lower RTS at the same level 75% as compared to Groups 1 and 3 at 96% and 82% respectively (p=0.017). Using multivariate logistic regression, Group 2 athletes were nearly 5 times more likely to have a Revision ACLR compared to Group 3 BTB athletes (OR: 4.92, 95% CI: 1.19 - 20.34, p=0.028). Females were nearly 3 times more likely to have a contralateral ACLR as compared to males (OR: 2.83, 95% CI: 1.09 - 7.34, p=0.033). Conclusion: As we hypothesized, the rate of revision ACLR and overall incidence of second surgery was higher and the RTS rate lower in Group 2 athletes compared to Groups 1 and 3 athletes. Group 2 athletes may be at higher risk because upon completion of their rehabilitation and RTS clearance process they are joining a cohort of competitive, now skeletally mature high school athletes who have not lost a year of athletic competition and development of sport-specific skills. Ultimately, the athlete’s skeletal age determined the choice of surgical technique, but the grade levels noted above demarcated the three surgical cohorts with only a few outliers. We believe grade level is important as this will most often dictate the level of competition that the athlete in question is exposed to after recovery and return to sport. This age and school grade risk profile is useful to counsel athletes and parents preoperatively regarding the expectations of surgery with regard to RTS and the risk of second surgery.
机译：目的：骨骼不成熟运动员的ACL损伤近年来已成为越来越重要的临床问题。 ACL重建（ACLR）后，年龄小于20岁的高风险运动员的运动返回率（RTS）最低，第二次手术率最高。这项前瞻性研究的目的是根据骨骼年龄，学业成绩分布和ACLR技术评估三组20岁以下小儿和青少年运动员的原发性ACLR的两年临床结局，重点是RTS和发生率第二次手术。我们假设与中（第2组）运动员相比，最年轻（第1组）和最老（第3组）的ACL修订版率较低，RTS率较高。方法：306名年龄小于20岁的患者在高级作者的实践中接受了原发性ACLR。第1组的剩余成长期为3-6年，由7年级的初中和初中运动员组成。第1组运动员接受了全-骨（AE）绳肌自体移植ACLR。第2组还有2-3年的成长时间，其中主要包括8年级和9年级的运动员。第2组用部分经phy骨（PTP）或完全经phy骨（CT）ham绳肌自体移植ACLR治疗。第3组包括骨骼肌成熟的高中和大学运动员，他们接受了CT ACLR人工骨腱（BTB）移植治疗。收集术前人口统计学，运动，损伤机制，术中发现，RTS和第二次手术数据。连续随访患者至少24个月。结果：这三个队列包括第1组（平均年龄：12.0 + 1.5y）的47名运动员（15％），第2组（平均年龄：14.3 + 1.3y）的64名运动员（21％）和195个运动员（64％） ）（第3组）（平均年龄：16.2 + 1.8y）。第2组的修正ACL率为20％（13/64名运动员），高于第1组的6％（3/47名运动员）和第3组的6％（11/195名运动员）（p = 0.001） 。与第1组和第3组的100％和94％相比，第2组运动员的RTS显着降低，为86％（p = 0.009）。与第1组和第3组（分别为96％和82％）相比，第2组运动员的RTS在相同水平75％时也显着降低（p = 0.017）。使用多元逻辑回归分析，与第3组BTB运动员相比，第2组运动员发生Revision ACLR的可能性高近5倍（或：4.92，95％CI：1.19-20.34，p = 0.028）。女性患对侧ACLR的可能性是男性的3倍（OR：2.83，95％CI：1.09-7.34，p = 0.033）。结论：根据我们的假设，与第1组和第3组运动员相比，第2组运动员的ACLR翻修率和第二次手术的总体发生率较高，而RTS率较低。第2组运动员的风险可能更高，因为在完成康复和RTS批准程序后，他们将加入一群充满竞技，现已骨骼成熟的高中运动员，他们并没有损失一年的体育比赛和特定运动技能的发展。最终，运动员的骨骼年龄决定了手术技术的选择，但以上提到的等级水平将三个手术队列划分为几个异常值。我们认为，年级水平很重要，因为这通常会决定该运动员在康复并重返运动后所面临的比赛水平。这种年龄和学校等级的风险状况有助于在术前就RTS的手术期望和第二次手术的风险为运动员和父母提供咨询。

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