Strength and functional performance recovery after anterior cruciate ligament reconstruction in preadolescent athletes

In the skeletally immature population, the rate of occurrence of anterior cruciate ligament (ACL) injuries and ACL reconstructions seems to be rising. Differences in surgical techniques, physiology, and emotional maturity could alter the rehabilitation progression and impact the outcomes when compared with adults. Reports of objective strength recovery and performance-based outcome measures after pediatric ACL reconstruction (ACLR) are limited. All patients that underwent all-epiphyseal ACLR from January 2008 to August 2010 were identified. Isokinetic peak quadriceps/hamstring torque values and functional performance measures in unilateral hopping tasks were extracted and compared with the noninjured limb. A limb symmetry index (LSI) of ≥90% was considered satisfactory. Complete data were available for 16 patients (mean age, 12.28 years; range, 8.51-14.88 years). By a mean 7 months (range, 3.02-12.56 years) after the operation, only 9 of 16 (56%) were able to achieve a satisfactory LSI for quadriceps strength. For hamstring strength, 15 of 16 (94%) were able to achieve satisfactory LSI. By a mean of 12 months (range, 5.39-24.39 months) postoperatively, only 6 of 16 subjects (38%) were able to achieve satisfactory performance on all functional hop tests. At a mean 15.42 months (range, 8.58-24.39 months) after surgery, only 4 of 16 (25%) subjects were able to achieve an LSI of ≥90% on all testing parameters.

For some pediatric patients, significant strength and functional deficits may be present at more than 1 year following ACLR. This population might need more prolonged rehabilitation programs to allow for sufficient recovery of strength and function because of unique characteristics of normal growth and development.