The objective of this study was to compare rates of anterior cruciate ligament (ACL) failure among adolescent patients to evaluate patella alta as a high-risk variable. Demographic and surgical data were retrospectively queried for patients ≤18 years of age with primary ACL reconstruction performed at a single academic center between 2011 and 2016 and minimum of 2-year clinical surveillance. Patellar height indices, including Caton–Deschamps index (CDI) and Insall–Salvati index (ISI), were retrospectively calculated from preoperative imaging to assess the presence of patella alta. Failure was defined as (1) ACL graft rerupture, (2) Lachman's grade 2 + , (3) presence of pivot shift, and (4) side-to-side difference of 3 mm on KT-1000 arthrometer. A total of 184 patients (84 females and 100 males) and 192 knees were identified, with an average age of 16.2 ± 1.8 years. Of these, 30 (15.63%) experienced ACL failure. Male sex was the only significant risk factor for rerupture (p = 0.026). The mean CDI was 1.06 ± 0.17 and mean ISI was 1.04 ± 0.15. Of the 49 knees that met criteria for patella alta on radiographic evaluation, rerupture occurred in seven (14.29%). Patella alta was not a significant risk factor for ACL failure among adolescent patients (p = 0.359 and 0.277). Only male sex was associated with increased rates of ACL failure. Age, graft selection technique, fixation construct, and presence of patella alta were not risk factors for reinjury. This study is a therapeutic case series and reflects level of evidence IV.

本研究的目的是比较青少年患者前十字韧带 (ACL) 衰竭的发生率，以将高位髌骨评估为高风险变量。回顾性查询 2011 年至 2016 年间在单一学术中心进行初次 ACL 重建且至少接受 2 年临床监测的 ≤18 岁患者的人口统计和手术数据。根据术前影像回顾性计算髌骨高度指数，包括卡顿-德尚指数（CDI）和因萨尔-萨尔瓦蒂指数（ISI），以评估高髌骨的存在。失败的定义为 (1) ACL 移植物再断裂，(2) Lachman 等级 2+，(3) 存在枢轴移位，以及 (4) KT-1000 关节计上的左右差异为 3 mm。总共确定了 184 名患者（84 名女性和 100 名男性）和 192 个膝盖，平均年龄为 16.2 ± 1.8 岁。其中，30 人（15.63%）经历过 ACL 失败。男性是再破裂的唯一显着风险因素 ( p  = 0.026)。平均 CDI 为 1.06 ± 0.17，平均 ISI 为 1.04 ± 0.15。在放射学评估中符合高髌骨标准的 49 个膝关节中，有 7 个膝关节发生再断裂（14.29%）。高髌骨不是青少年患者 ACL 失败的显着危险因素（p  = 0.359 和 0.277）。只有男性与 ACL 失败率增加相关。年龄、移植物选择技术、固定结构和高髌骨的存在不是再次损伤的危险因素。本研究是一个治疗性病例系列，反映了证据级别 IV。