Predictors of Functional Recovery After ACL Reconstruction in Mid-Teen Patients: An Analysis of Clinical and Rehabilitation Factors
Author(s): Sanjay Kumar Sureen, Dialdeen Mohamed Youssef, Hassan Yousuf Bilal
Background: ACL injuries in mid-teen athletes are increasing, and recovery after ACL reconstruction is variable despite surgery and clearance to return to sport. Functional recovery depends on both subjective function and objective performance, and may be influenced by preoperative clinical status, associated meniscal or cartilage injuries, surgical factors, and, importantly, rehabilitation dose and adherence. The study aimed to identify independent predictors of functional recovery at 12 months after primary ACL reconstruction in midteen patients.
Methods: This observational analytical study included mid-teen boys and girls undergoing primary unilateral ACL reconstruction at Prime Hospital, Dubai, UAE, during two years from January 2024 to December 2025, with prospective follow-up where feasible. Preoperative and intraoperative variables were recorded using a structured form. Patients were assessed at routine intervals up to 12 months. Functional recovery at 12 months was evaluated using IKDC or Pedi-IKDC and, where applicable, objective criteria such as hop-test symmetry, full ROM, and absence of clinically relevant effusion. Data were analyzed in SPSS v26 using descriptive statistics, bivariate tests, and multivariable regression to identify independent predictors, with ethical approval and de-identified data handling.
Results: Of 350 mid-teen ACL reconstruction patients, 216 (61.7%) achieved functional recovery at 12 months. Recovery was higher in males (68.5% vs 56.7%; p=0.025), those with lower BMI (23.6±3.8 vs 25.0±4.5; p=0.002), higher baseline activity (Tegner 6.4±1.3 vs 5.9±1.4; p=0.001), and greater preinjury sports participation (90.7% vs 82.1%; p=0.017). Non-recovered patients had more swelling (72.4% vs 59.3%; p=0.014), longer injury-to-surgery delay (104 vs 72 days; p=0.001), worse pre-op pain/ROM/effusion (all p<0.001), and more cartilage and MCL injury (p≤0.045). Rehabilitation showed the biggest differences, with earlier start, supervised physiotherapy, better adherence, and higher milestone achievement all favoring recovery (all p<0.001). At 12 months, recovered patients had higher IKDC (88.7±6.8 vs 73.4±9.8) and better hop and strength symmetry (all p<0.001), and returned to sport earlier (8.7±1.9 vs 10.2±2.3 months; p<0.001). Independent predictors were lower BMI (AOR 0.93; p=0.004), shorter delay to surgery (AOR 0.89 per 30 days; p=0.016), no cartilage injury grade ≥2 (AOR 0.60; p=0.038), supervised physiotherapy (AOR 2.14; p=0.004), good-to-excellent adherence (AOR 3.21; p<0.001), and full extension by 2 weeks (AOR 2.63; p<0.001), with male sex modestly associated (AOR 1.55; p=0.045).
Conclusion: Functional recovery at 12 months was achieved in nearly twothirds of mid-teen patients after ACL reconstruction, with substantially better patient-reported and objective function among those who recovered. Recovery was independently associated with modifiable rehabilitation factors, including supervised physiotherapy, good-to-excellent adherence, and achieving full extension by 2 weeks, while higher BMI, longer injury-to-surgery delay, and cartilage injury predicted poorer outcomes.