Anterior Cruciate Ligament Regeneration in an 8-Year-Old Patient

Abstract

Each year, the overall incidence of anterior cruciate ligament (ACL) rupture in the United Kingdom is 1:3,000. Among children and adolescents, the incidence increases because of a rising number of young athletes acting at high activity level, together with an increased awareness of such knee injuries amongst doctors.1 Their incidence is approaching the adult's incidence of ACL ruptures. 2,3 The majority of patients younger than 12 years with an ACL injury have tibial eminence avulsion. Most patients older than 12 years suffer nonosseous ACL lesions. This can be explained by an increasing rigidity of the skeleton during growth. 4The ACL plays a central role in the AP translation and rotation of the tibia. A ruptured ACL often interferes with daily, physiological stability of the knee.5 Because of poor spontaneous healing potential, different treatment strategies of the torn ACL have been reported; patients with functional instability often require ACL reconstructive surgery. 6 Treatment of a ruptured ACL in the skeletally immature patient remains controversial and the current evidence is low. 7-9 ACL reconstruction may cause harm to the growth plate with subsequent growth disturbances or deformities, despite techniques that diminish physeal violation. 4 On the contrary, delayed reconstruction till skeletal maturity increases possible additional intra-articular knee damage. 3,10 Conservative treatment requires modification of activities and treatment compliance. This is not an easy task for the young athlete, often competing at a physically demanding level. 7,8 Preservation of the own, functional ACL after rupture would be an ideal situation. Treating this group of patients is challenging and often a dilemma. Therefore, in the last decades, several researchers in different fields have challenged the regeneration potential of the ACL. 5,9,11-15We report a case with clinical and radiological regeneration of a midsubstance ACL rupture in an 8-year-old patient with conservative treatment. Case ReportAn 8-year-old boy presented at the outpatient clinic with a giving way sensation of the right knee. He played football at recreational level and had suffered a noncontact rotational knee trauma in a football match 3 weeks earlier. At the time of injury, immediate swelling occurred with complaints of giving way. Physical examination showed a healthy child, body mass index of 16 kg/m 2 , with slight swelling of the right knee with full range of motion; Lachman test 6 to 10 mm, anterior drawer test 6 to 10 mm, and a pivot shift 1; IKDC AbstractRuptured anterior cruciate ligaments (ACL) have doubtful healing potential. This might be better in younger patients. Therefore, treatment of an ACL rupture in the skeletally immature patient knows several strategies. We report the case of an 8-year-old, skeletally immature patient with a midsubstance-ruptured ACL at physical exam and magnetic resonance imaging (MRI). Conservative treatment with a brace led to a stable knee with regeneration of the ACL on both the physical examination a...