Because kids are specializing in competitive sports at an increasingly early age, serious injuries typically only seen in adults are now on the rise in young athletes. This includes anterior cruciate ligament (ACL) injuries. According to a study in Pediatrics, “ACL Tears in School-Aged Children and Adolescents Over 20 Years,” there was an annual increase of 2.3% from 1994 to 2013.
But it is not just an initial ACL injury that is on the rise in young players. Surgeons are also seeing a rise in second and third ACL injuries. One recent study by Dekker et al. published in The Journal of Bone & Joint Surgery (“Return to Sport After Pediatric Anterior Cruciate Ligament Reconstruction and Its Effect on Subsequent Anterior Cruciate Ligament Injury”) reported that 84% of pediatric patients (age range, 6-17 years) were able to return to the same preinjury level of competition sport after primary reconstruction surgery, but 32% sustained a second ACL injury.
And to make matters worse, many of the athletes who undergo revision ACL reconstruction to treat a second ACL injury will go on and suffer a third injury as well. Revision surgery has been associated with a 3 or 4 times higher failure rate than primary reconstruction surgery. The why in all of this though is still not completely understood.
Some data has suggested that the presence of meniscal and chondral lesion during the revision surgery, bone tunnel management during surgery and even the rate of return to high risk sports may play a role. “Revision Anterior Cruciate Ligament Reconstruction Outcomes in Younger Patients: Medial Meniscal Pathology and High Rates of Return to Sport Are Associated With Third ACL Injuries,” a study published in the January 2018 issue of the American Journal of Sports Medicine, explored these potential risk factors for multiple ACL injuries and found that medial meniscal pathology and high return to sports (RTS) rates are the most likely culprits.
Understanding Knee Pathology
In this case-control study, 151 consecutive patients who were 25 years old or younger at time of their first revision anterior cruciate ligament (ACL) reconstruction were followed for a mean of 4.5 years (range, 2-9 years) to track the number of subsequent ACL injuries (graft re-rupture or contralateral injury to the native ACL) that occurred during this time. All of the revision ACL surgeries took place between June 2007 and July 2014 by two surgeons. Both surgical details as well as a range of sport participation outcomes were measured.
