Summary
The incidence of pediatric ACL reconstruction (ACLR) in Norway has significantly increased since 2005, with a 40% rise for boys and a 55% rise for girls, accompanied by a notable shift from meniscal resection to repair as the most common concomitant procedure, as well as long-term patient-reported outcomes indicating persistent knee function impairment.
Abstract
Background
The incidence of pediatric and adolescent anterior cruciate ligament reconstruction (ACLR) is increasing in several countries. It is uncertain whether this applies to countries with a more conservative treatment approach, like Norway. Nationwide, long-term patient reported outcomes and risk of revision following ACLR in the pediatric population are also lacking.
Purpose
The primary aim was to determine the incidence of pediatric ACLR in Norway since 2005. Secondary aims were to detect trends in surgical details and describe patient reported outcomes up to ten years following ACLR.
Study Design: Cohort study.
Methods
This descriptive study is based on prospectively collected data on girls = 14 years and boys =16 years, registered in the Norwegian Knee Ligament Register at the time of their primary ACLR, from 2005 through 2021. Main outcome was the incidence of ACLR, adjusted to the corresponding population numbers for each year, and by comparing the mean of the first and last 3-year period (2005-2007 with 2019-2021). Patient reported outcomes were assessed with the Knee Injury and Osteoarthritis Score (KOOS) preoperatively and at 2, 5 and 10 years.
Results
1484 cases were included, with mean follow-up of 7.9 years (95% CI 7.7-8.2). The incidence of pediatric ACLR per 100,000 population increased from 18 to 26, which corresponds to an increase of 40% for boys and 55% for girls. Concurrent meniscal procedures increased significantly from 45 to 62%; and the proportion of meniscal repairs increased from 19 to 43% when comparing the first and the last time-period. Mean KOOS-scores for the Sport- and Quality of Life subscales were between 72-75 at 2-, 5- and 10-year follow-up. The overall 5-year revision rate was 9.9%.
Conclusion
There was a major increase in incidence of pediatric ACLR in Norway during the study period. The most common concomitant meniscal procedure shifted from resection to repair, with over a doubling of the proportion of meniscal repairs. Patient reported outcomes revealed long-lasting reduced knee function.