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.Purpose: 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.Study Design: 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).Conclusion: 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.
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机译：背景：关于前十字韧带（ACL）生存的文献以及在儿童和青少年初次ACL重建后导致进一步ACL损伤的变量的文献有限，没有长期证据检查进一步ACL损伤的发生率和影响因素目的：确定18岁患者初次重建后ACL移植物和对侧ACL（CACL）的长期存活率，并确定增加后续ACL损伤几率的因素。研究设计：案例系列；证据水平，4。方法：本研究考虑了1993年至1998年间在18岁时接受原发性ACL重建的患者，该患者由一名外科医生纳入前瞻性数据库。单切口内镜ACL重建可采用自体骨–腱-骨移植或绳肌腱移植进行。 ACL重建后至少15年，患者完成了涉及国际膝关节文献委员会（IKDC）问卷的主观调查，此外还询问了有关当前症状，进一步的ACL损伤，ACL损伤家族史和当前活动水平的问题。 ：共有288名青少年（年龄范围13-18岁）符合纳入标准，其中242名（84％）在ACL重建后的平均16年零6个月时接受了检查。在这些患者中，有75例（31％）进一步受到ACL损伤：27例（11.2％）遭受了ACL移植物破裂，33例遭受了CACL损伤（13.6％），15例同时遭受了ACL移植物破裂和CACL损伤（6.2 ％）超过15年。在1、2、5、10和15年时，ACL移植物的存活率分别为95％，92％，88％，85％和83％，CACL的存活率分别为99％，98％，90％ ，分别为83％和81％。有ACL损伤家族史的患者的ACL移植存活率较无家族史的患者低（分别为69％和90％；危险比[HR]，3.6； P = .001）。男性患者的CACL存活率较女性患者低（分别为75％和88％； HR，2.1； P = .03），以及参加竞技团体运动的患者比未接受CACL的患者（78）结论分别为：％vs. 89％； HR，2.3； P = .05）。结论：18岁患者进行ACL重建后，在15年中，每3名患者中又有1名发生了ACL损伤。 ACL移植物的15年生存率为83％，CACL的15年生存率为81％。 ACL移植物和CACL在指标手术后的前5年内最易受伤害。 ACL破裂的家族病史显着增加了ACL移植物破裂的风险，并且CACL损伤在男性患者和重返团队运动的患者中更为常见。在青少年人群中进行ACL重建后，长期保持较高的IKDC分数并继续参与体育运动。
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