Higher revision and secondary surgery rates after ACL reconstruction in athletes under 16 compared to those over 16: a case-control study

PMCID: PMC12172342

PMID: 40528219

DOI: 10.1186/s13018-025-05935-5

Journal: Journal of orthopaedic surgery and research

Publication Date: 2025-6-17

Authors: Tátrai M, Halasi T, Tállay A, Tátrai A, Karácsony AF, et al.

Key Points

• Adolescent athletes under 16 have a 44% total secondary surgery rate compared to 21% in older patients
• Female adolescent athletes have a 92% contralateral ACL reconstruction rate
• Clinicians should anticipate higher surgical intervention risks and more complex rehabilitation for younger ACL reconstruction patients

Summary

This retrospective study investigated anterior cruciate ligament (ACL) reconstruction outcomes in patients under and over 16 years of age, revealing significant differences in surgical and clinical outcomes. The research compared two groups (average ages 15.2 and 30.8 years) across multiple patient-reported outcome measures and surgical intervention rates, highlighting the unique challenges faced by adolescent athletes undergoing ACL reconstruction.

The study demonstrated that younger patients (Group 1) experienced substantially higher rates of secondary surgical interventions, including contralateral ACL reconstructions (18.3% vs. 1.1%, p=0.03) and meniscus surgeries (26% vs. 4.6%, p=0.003). Notably, female adolescent athletes showed a significantly higher rate of contralateral ACL reconstruction (92% vs. 69%, p=0.020). While overall functional outcomes were similar, younger patients exhibited significantly different symptom profiles, with lower symptom scores (75.6 vs. 85.0, p<0.005) and slightly higher pain scores.