One ACL Tear Is Disappointing; A Re-tear Is A Problem

December 17, 2019 | Knee

By Dev K. Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • About 10% of adolescents and teenagers are at risk for a re-tear of an ACL reconstruction surgery
  • If you need a second ACL surgery, the return to sport rates are low
  • Athletes of all ages should ensure that they are fully recovered from the first surgery before returning to sport, in order to reduce their chance of a re-tear

ACL tears in young athletes are becoming more common, and surgery to rebuild a new ACL is also increasingly common. If you happen to be a young athlete with an ACL tear, the thought of needing surgery, a lengthy recovery, and time away from your favorite sport activities can be truly disappointing.

Technical advancements allow us to do the surgery with accuracy, avoid growth disturbances, and with a very favorable outcome in about 90% of teenagers and adolescents. But some people will re-tear the new ACL, requiring what is called “revision ACL reconstruction.” The unfortunate reality is that the results from revision surgery are not as good as the original surgery. The failure rate is about 20%, which is a real problem for those athletes needing the second surgery.

The number of ACL tears in adolescents seems to be increasing at about 2% annually. There are a number of factors contributing to the rise, including increased focus on a single high demand sport, and greater emphasis on beginning year-round sports at an earlier age. An untreated ACL injury tends to be debilitating for athletes who wish to continue to lead an active lifestyle. Many of those young athletes will choose ACL reconstructive surgery.

The first surgery is referred to as the “primary” operation, and primary ACL reconstructions tend to be highly successful; however, adolescents and teenagers are at higher risk of graft failure than adults. Athletes younger than 20 years show significantly higher failure rates. Most clinical studies report a failure rate of around 10% in athletes under age 20. The failure rate in adults is closer to 4%.

This recent clinical study from Rady Children’s Hospital and UCSD shows a far different picture for outcomes after the revision operation for a re-tear of the first surgery. The re-tear rate for the revision surgery was 21%, and most unfortunately only 27% of the athletes were able to return to their same sport level participation.

My Key Takeaways

 My first take away is that you need to do everything possible to ensure a successful outcome from the first ACL surgery. I would strongly recommend that you take as much time as is necessary to ensure proper return of strength, speed, power, and agility necessary to safely play your sport. If your original injury was from a noncontact event, you need to ensure that your landing and cutting mechanics are perfect when you come back from your first ACL surgery.

And my second take away is that if you are unlucky to re-tear the first ACL surgery, you need to see an orthopedic sports specialist specifically trained in ACL revision surgery in your age group. You will oftentimes find these surgeons at clinical practices associated with major university teaching centers. Be sure to see the right doctor to give yourself the best chance of a successful outcome from revision ACL surgery.





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