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ACL re-injury appears to be a subject of 'relative risk'

November 02, 2018

ORLANDO, Fla. - Children who have an immediate family member with a history of anterior cruciate ligament (ACL) tears are more likely to experience future complications that require additional surgical repair.

The study abstract "'Relative' Risk of ACL Re-Injury," will be presented on Saturday, Nov. 3 at the American Academy of Pediatrics 2018 National Conference & Exhibition in Orlando, Fla. Researchers aimed to identify the proportion of pediatric ACL patients with a first-degree relative (mother or father) who had suffered an ACL tear.

Researchers examined data from 425 childhood patients who underwent primary (no previous tears) ACL reconstruction at an urban tertiary care children's hospital between January 2009 and May 2016. Approximately 4 years after surgery, patients were contacted and asked to complete a follow up survey. The survey asked about complications after surgery, including graft rupture, additional ACL injury and meniscus tears - along with questions about whether other relatives may have suffered an ACL tear in the past.

The survey results found that the average age at surgery was 15 years old. Researchers then divided these patients into three groups by the number of relatives who had experienced an ACL tear: those with no relatives experiencing ACL tear, those with one relative with the condition, and those with more than one relative with the condition. Of the patients who experienced primary ACL repair, 23 percent had at least one first-degree relative with a previously torn ACL, and 3 percent had more than one-first degree relative with an ACL tear.

Graft failures were 40 percent more likely in children who had two or more first-degree relatives with ACL tears. Patients in this group were 66 percent more likely to develop complications that involved additional surgeries, compared to those with no family history (or only one family member) of previous ACL injury. However, across the groups, there was no difference in the number of meniscus or ligamentous injuries when family history was considered.

"By showing that pediatric ACL patients who have strong family histories of ACL tears are more prone to subsequent complications, we hope that our research will influence awareness and post-operative rehabilitation protocols," said Theodore Ganley, MD, director, Sports Medicine and Performance Center at the Children's Hospital of Philadelphia, and associate professor of orthopaedic surgery at the Hospital of the University of Pennsylvania.

While several other studies have examined ACL injuries in relatives of ACL patients, they have mostly included adult patients, and few have looked at post-operative outcomes. This study adds to the existing research by reporting on family histories of ACL tears and its impact on the pediatric population. It also addresses post-operative outcomes for patients with strong ACL family histories.

Josh Bram will present the abstract, available below, at Saturday, Nov. 3, at 9 a.m. ET in the Plaza International Ballroom DE of the Orange County Convention Center.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media or may be preparing a longer article for submission to a journal.
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.

Abstract Title: 'Relative' Risk of ACL Re-injury

Joshua Bram

Philadelphia, PA

Purpose Several studies have examined ACL injury history among relatives of patients undergoing ACL reconstruction, but they have primarily analyzed adult populations with variable results. Additionally, few studies have examined concomitant injuries or post-operative outcomes among pediatric patients with a family history of ACL tear. Therefore, the purpose of this study was to identify the proportion of pediatric ACL patients with a first degree relative who had suffered an ACL tear while also examining concomitant meniscal or ligamentous injuries and subsequent complication rates. Methods 1009 patients who underwent ACL reconstruction at an urban tertiary care children's hospital between January 2009 and May 2016 were contacted via email and/or telephone and asked to complete a follow-up survey. Data collected included subsequent complications - including graft rupture, contralateral ACL injury, and meniscus tears - along with information regarding any relatives who had suffered an ACL tear. Patient medical records were reviewed to determine the age of the patient at the time of surgery as well as concomitant meniscus and ligamentous injuries at the time of injury. Results 425 patients who underwent primary ACL reconstruction completed the survey. The mean age at surgery was 15.0 (SD 2.4) years with a mean follow-up time of 4.6 (SD 2.1) years. Patients were stratified into three groups by the number of first degree relatives (parent or sibling) who had an ACL tear history: no relatives, one relative, or more than one relative. 101 respondents (23.8%) reported at least one first degree relative who had previously torn an ACL. 15 (3.5%) had more than one first degree relative with an ACL tear. There were no differences in the age at time of surgery or the number of concomitant meniscus and ligamentous injuries suffered across the three stratified groups. While children with zero or one affected first degree relative had similar rates of graft failure (11.4% and 9.3%, respectively), those with two or more affected first-degree relatives had a significantly higher graft failure rate (40.0%, p=0.003). There were no differences in the number of post-operative contralateral ACL tears (p=0.44) or meniscus tears (p=0.48) across the groups. When these complications were analyzed together as one outcome, patients with more than one affected first-degree relative suffered more combined graft ruptures, contralateral ACL tears, and meniscal tears (53.3%) than patients with zero (21.9%) or only one affected first degree relative (22.1%, p=0.02). This group of patients also suffered more total complications that required surgical intervention (66.7%) than patients with zero (21.0%) or only one affected first degree family member (22.1%, p<0.001). Conclusions Patients undergoing primary ACL reconstruction who have a strong family history of ACL tear appear more likely to suffer a post-operative graft rupture and suffer a complication requiring surgery.

American Academy of Pediatrics

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