An arthroscopic repair technique for proximal anterior cruciate tears in children to restore active function and avoid growth disturbances

Abstract

Purpose The aim of this study was to assess midterm clinical outcomes in Tanner 1–2 patients with proximal anterior cruciate ligament (ACL) tears following arthroscopic-surgical repair using an absorbable or an all-suture anchor. Methods Fourteen (9.2 ± 2.9 years-old) of 19 skeletally immature patients reached the 2 years of clinical follow-up. Physical examinations included the Lachman test, Pivot-shift test, One-leg Hop test, Pedi-IKDC as well as Lysholm and Tegner activity scores; knee stability was measured with a KT-1000 arthrometer. Overall re-rupture rates were also evaluated in all operated patients. Results At 2 years post-surgery, the Lysholm score was 93.6 ± 4.3 points, and the Pedi-IKDC score was 95.7 ± 0.1. All patients returned to the same sport activity level as prior to ACL lesion within 8.5 ± 2.9 months, with one exception who reported a one-point reduction in their Tegner Activity score. No leg-length discrepancies or malalignments were observed. Four patients presented grade 1 Lachman scores, and of these, three presented grade 1 (glide) score at Pivot-shift; clinical stability tests were negative for all other patients. Anterior tibial shift showed a mean side-to-side difference of 2.2 mm (range 1–3 mm). The One-leg Hop test showed lower limb symmetry (99.9% ± 9.5) with the contralateral side. Overall, 4 out of 19 patients presented a re-rupture of the ACL with a median time between surgery and re-rupture of 3.9 years (range 1–7). Conclusion This surgical technique efficiently repairs proximal ACL tears, leading to a restoration of knee stability and a quick return to an active lifestyle, avoiding growth plate disruption. Level of evidence IV.

Resolvin E1 and Cytokines Environment in Skeletally Immature and Adult ACL Tears

“…By comparison, we reported a 5-case series of proximal ACL injuries in children treated with a surgical ACL repair, with a 100% success rate ( 39 ). This kind of series suggests that the healing potential in children is a strong factor to consider in pre-operative surgical planning and repair has to be considered in cases of proximal lesions in young patients ( 40 ). By comparison, Gagliardi et al reported a graft failure rate 10 times higher in skeletally immature patients that underwent ACL repair compared to ACL reconstruction.…”

Characterization of microRNA Levels in Synovial Fluid from Knee Osteoarthritis and Anterior Cruciate Ligament Tears

“…Interestingly, we observed that 10 miRNAs were detectable in both adult and adolescent groups with ACL tears without a meniscal tear. More pre-clinical studies are needed to better understand the intraarticular biochemical process in the healing potential of ACL tears in skeletally immature patients [ 41 , 42 , 43 , 44 , 45 ].…”

Surgical techniques in the management of pediatric anterior cruciate ligament tears: Current concepts

“…Direct repair of proximal ACL tears shows good clinical and patient reported outcomes at short and midterm follow-up. 86 , 87 , 90 Augmented techniques which use non-absorbable materials show high rates of re-operation and failure in both adults and the skeletally immature, with re-operation rates in adolescent patients over 10 times higher than ACLR. 87 Conversely, the use of non-absorbable augmentation for an initial period of 3 months, followed by extraction, may be associated with adequate clinical outcomes at 2 years’ post-operatively.…”