Surgical Management of the Failed Pediatric ACL Reconstruction

While growth disturbance related to anterior cruciate ligament reconstruction (ACL-R) in the pediatric athlete is a feared complication, perhaps the most devastating complication of ACL reconstruction surgery in this population is reinjury. When ACL graft tear occurs, revision ACL-R is typically recommended for patients who wish to continue high-level sports participation. As with adult patients, a comprehensive assessment of factors contributing to graft failure should be performed, and each factor systematically addressed. Key considerations for pediatric patients include the status of the growth plates as well as the possibility that a physeal-sparing or physeal-respecting surgical technique may have been previously employed. In addition, understanding how a young athlete’s psychological state and developmental level may affect his/her/their risk for re-injury is essential for achieving a safe and injury-free return to sport following revision ACL-R. Surgical outcomes in this population have not yet been optimized, with graft re-tear rates reported to approach 20%, and young athletes undergoing revision ACL-R should be counseled accordingly.