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Over 90 % of children and adolescents return to sport after anterior cruciate ligament reconstruction: a systematic review and meta-analysis

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate the rate at which children and adolescent athletes return to sporting activities after anterior cruciate ligament (ACL) reconstruction.

Methods

Three databases, PubMed, MEDLINE, and EMBASE, were searched from database inception until September 9, 2017 by two reviewers independently and in duplicate. The inclusion criteria were English language studies that reported return to sport outcomes. Book chapters, conference papers, review articles, and technical reports were excluded. The rate of return to sports was combined in a meta-analysis of proportions using a random-effects model.

Results

Overall, 20 studies with a combined total of 1156 ACL reconstructions met the inclusion criteria, with a mean age of 14.3 years (range 6–19) and a mean follow-up time of 6.5 years (range 1–22). All studies were level IV evidence (14 retrospective case series and 6 prospective case series). The pooled rate of return to any sport participation was 92.0% [95% confidence interval (CI), 86–96%]. The pooled rate of return to pre-injury level of sport was 78.6% (95% CI 71–86%) and that to competitive level of sport was 81.0% (95% CI 62–94%). A total of 93 of the 717 assessed athletes (13%) sustained re-injuries with graft ruptures, and in 91 of 652 patients (14%), contralateral ACL injuries were reported on final follow-up.

Conclusion

Pooled results suggest a high rate of return to sport following ACL reconstruction in children and adolescent athletes; however, this is associated with a relatively high rate of graft rupture and a similar rate of contralateral ACL injury. This study provides clinicians with evidence-based data on the ability of children and adolescent athletes to return to sport after ACL reconstruction, an important consideration for athletes of this population with ACL injuries.

Level of evidence

IV, systematic review of level IV studies.

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Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Jeffrey Kay, Muzammil Memon, Devin Peterson & Olufemi R. Ayeni

  2. Department of Orthopedic Surgery and Sports Medicine, Hospital for Special Surgery, 535 E 70th St, New York, NY, USA

    Robert G. Marx

  3. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

    Nicole Simunovic

  4. McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada

    Olufemi R. Ayeni

Authors
  1. Jeffrey Kay
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  2. Muzammil Memon
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  3. Robert G. Marx
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  4. Devin Peterson
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  6. Olufemi R. Ayeni
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Corresponding author

Correspondence to Olufemi R. Ayeni.

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Conflict of interest

The authors declare no competing financial interest.

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Ethical approval

This is a systematic review of the literature and no ethics approval is required.

Informed consent

Informed consent was not applicable to this study.

Appendix

Appendix

See Table 6.

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Kay, J., Memon, M., Marx, R.G. et al. Over 90 % of children and adolescents return to sport after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 26, 1019–1036 (2018). https://doi.org/10.1007/s00167-018-4830-9

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