Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 4, pp 1019–1036 | Cite as

Over 90 % of children and adolescents return to sport after anterior cruciate ligament reconstruction: a systematic review and meta-analysis

  • Jeffrey Kay
  • Muzammil Memon
  • Robert G. Marx
  • Devin Peterson
  • Nicole Simunovic
  • Olufemi R. Ayeni



To evaluate the rate at which children and adolescent athletes return to sporting activities after anterior cruciate ligament (ACL) reconstruction.


Three databases, PubMed, MEDLINE, and EMBASE, were searched from database inception until September 9, 2017 by two reviewers independently and in duplicate. The inclusion criteria were English language studies that reported return to sport outcomes. Book chapters, conference papers, review articles, and technical reports were excluded. The rate of return to sports was combined in a meta-analysis of proportions using a random-effects model.


Overall, 20 studies with a combined total of 1156 ACL reconstructions met the inclusion criteria, with a mean age of 14.3 years (range 6–19) and a mean follow-up time of 6.5 years (range 1–22). All studies were level IV evidence (14 retrospective case series and 6 prospective case series). The pooled rate of return to any sport participation was 92.0% [95% confidence interval (CI), 86–96%]. The pooled rate of return to pre-injury level of sport was 78.6% (95% CI 71–86%) and that to competitive level of sport was 81.0% (95% CI 62–94%). A total of 93 of the 717 assessed athletes (13%) sustained re-injuries with graft ruptures, and in 91 of 652 patients (14%), contralateral ACL injuries were reported on final follow-up.


Pooled results suggest a high rate of return to sport following ACL reconstruction in children and adolescent athletes; however, this is associated with a relatively high rate of graft rupture and a similar rate of contralateral ACL injury. This study provides clinicians with evidence-based data on the ability of children and adolescent athletes to return to sport after ACL reconstruction, an important consideration for athletes of this population with ACL injuries.

Level of evidence

IV, systematic review of level IV studies.


Pediatric Adolescent Child Anterior cruciate ligament reconstruction Sport 


Compliance with ethical standards

Conflict of interest

The authors declare no competing financial interest.



Ethical approval

This is a systematic review of the literature and no ethics approval is required.

Informed consent

Informed consent was not applicable to this study.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Jeffrey Kay
    • 1
  • Muzammil Memon
    • 1
  • Robert G. Marx
    • 2
  • Devin Peterson
    • 1
  • Nicole Simunovic
    • 3
  • Olufemi R. Ayeni
    • 1
    • 4
  1. 1.Division of Orthopaedic Surgery, Department of SurgeryMcMaster UniversityHamiltonCanada
  2. 2.Department of Orthopedic Surgery and Sports MedicineHospital for Special SurgeryNew YorkUSA
  3. 3.Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonCanada
  4. 4.McMaster University Medical CentreHamiltonCanada

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