2015 ISAKOS Biennial Congress ePoster #1358

Long Term Follow Up of Pediatric ACL Reconstruction in New York State: High Rates of Subsequent ACL Reconstruction

Emily Dodwell, ND, New York, NY UNITED STATES
Moira McCarthy, MD, New York, NY UNITED STATES
Ting Jung Pan, MPH, New York, NY UNITED STATES
Daniel W. Green, MD, MS, New York, NY UNITED STATES
Frank A. Cordasco, MD, MS, New York, NY UNITED STATES
Stephen L. Lyman, PhD, New York, NY UNITED STATES

Hospital for Special Surgery, New York, New York, USA

FDA Status Not Applicable

Summary: The rates of ACL reconstruction in pediatric and adolescent patients is increasing and there are high rates of subsequent ACL surgery and subsequent non-ACL knee surgery in the young population.

Rate:

Abstract:

Introduction

The rate of pediatric anterior cruciate ligament (ACL) reconstruction has recently been assessed on a population level; in New York State there is a pediatric ACL reconstruction epidemic. To date, no population level evidence exists to quantify the rate of subsequent ACL surgery, or additional knee surgery in children that have undergone ACL reconstruction.

Purpose

The primary aim of the current study was to determine the rate of subsequent ACL reconstruction and additional non-ACL knee surgery in children that had previously undergone ACL reconstruction in New York State. The secondary aim was to assess factors associated with additional ACL and non-ACL knee surgery.

Study Design: Retrospective Cohort

Methods

Pediatric patients (age < 21) who underwent ACL reconstruction between 1997 and 2010 in New York State were identified using the Statewide Planning and Research Cooperative System (SPARCS) database. Patients were tracked for return to the OR for subsequent ACL reconstruction and additional non-ACL knee surgery. Follow up was to 2011 inclusive such that each case had a minimum of one year follow up. A Cox proportional hazards model was used to assess time to subsequent surgery, adjusting for age, sex, race, comorbidity index, insurance type, surgeon and hospital ACL volume, and poverty prevalence.

Results

23912 primary pediatric ACL reconstructions were identified. 1955 patients (8.2%) underwent subsequent ACL reconstruction. 7.4% had one additional ACL reconstruction and 0.7% had two or more additional ACL reconstructions. 3341 patients (14% ) had subsequent non-ACL knee surgery with 11.1% having one subsequent surgery and 2.9% having two or more additional knee surgeries. Risk factors for revision ACL surgery were younger age at time of the primary ACL surgery (p<0.001), male gender (p<0.001), white race (p=0.003), private insurance (p<0.001), higher hospital ACL volume (>20 per year; p=0.002), and higher surgeon ACL volume (>10 per year; p=0.003). Risk factors for return to the OR for other non-ACL knee surgery were younger age at the time of primary ACL reconstruction (p<0.001), white race (p<0.001), private insurance (p=0.016), and higher hospital ACL volume (>20 per year; p=0.007).

Conclusion

This study is the first to evaluate, on a population level, the rate of subsequent ACL surgery and additional non-ACL knee surgery following primary pediatric ACL reconstruction. 8.2% of children with a primary ACL reconstruction required additional ACL reconstructions, while 14% required additional non-ACL knee surgery. Males and younger patients had a higher rate of subsequent ACL reconstruction. Higher rates of ACL reconstruction in younger children may be due to greater at-risk activities in younger children, longer follow up, or inherently less reliable reconstructions given the non-anatomic reconstructions that are frequently required in the skeletally immature. Risk factors for return to the OR for additional non-ACL knee surgery included younger age at time of the index procedure, white race, higher hospital ACL volume, and private insurance. The association between socioeconomic factors and increased subsequent knee surgeries likely represents a disparity in access to care for low socioeconomic status patients.