A large study following more than 1,300 adolescents who had anterior cruciate ligament reconstruction found that 30% suffered a second injury within 10 years.
Most of the adolescents also had additional knee damage at the time of surgery, with 71% reporting meniscus or ligament injuries.
Investigators tracked 1,392 patients aged 10 to 18 years who underwent anterior cruciate ligament (ACL) reconstruction. The average age at surgery was 16 years, and participants completed a follow-up survey nearly 10 years later. Soccer was the most commonly reported sport prior to injury, followed by handball, hockey, and basketball.
Second ACL injuries were reported among 20% of the participants on the same knee (ipsilateral) and 13% on the opposite knee (contralateral). Nine percent sustained injuries in both knees. Reinjury rates were similar between male and female participants and across sports, although hockey players had higher rates of contralateral injury.
Concomitant injuries occurring at the time of the ACL tear were frequent. Medial meniscus tears were found in 24% of the athletes and lateral meniscus damage in 28%. Injuries to the medial collateral ligament were more common in handball players.
Despite these complications, 92% of adolescents returned to sport postsurgery. Between 64% and 76% returned to their preinjury level of performance, depending on the sport. However, 8% didn't return at all, with a higher rate among females compared with males (9% vs 4%).
Elite-level competition declined postsurgery. Prior to injury, 39% of the athletes competed at a junior national level or higher. That number dropped to 24% following reconstruction. Still, many athletes were able to continue high-level participation after surgery.
Knee function was measured using the Knee Injury and Osteoarthritis Outcome Score. Across all sports, scores improved significantly between surgery and the 1- and 2-year follow-ups. Gains were observed in symptoms, pain, daily living, sports activity, and quality of life.
The investigators emphasized the value of understanding sport-specific injury patterns to inform treatment and recovery. They also highlighted the need for long-term injury prevention strategies, particularly for adolescents returning to high-impact sports.
The findings suggested that while ACL reconstruction in adolescence often resulted in improved knee function and sport resumption, the risk of reinjury and ongoing joint damage remained considerable.
Full disclosures can be found in the published study.
