Anterior cruciate ligament tears in skeletally immature patients: Meniscal pathology at presentation and after attempted conservative treatment

Pediatric anterior cruciate ligament reconstruction

“…Non-operative management as the definitive treatment of ACL deficiency in children and adolescents is not recommended as it leads to intra-articular injury, functional impairment and joint degeneration [6,7,11]. Because ACL injury in children tends to occur within 6-12 months of skeletal maturity [28] some authors advocate short term non-operative management with delayed, anatomic ACL reconstruction.…”

“…If skeletally immature patients with ACL injury continue to be active in recreational play or competitive sports they risk chondral or meniscal injury which can lead to early osteoarthritis [6,7]. ACL reconstruction may improve knee function, avoid strict activity modification and reduce intraarticular injuries due to instability episodes [6, 8, 9•, 10, 11].…”

Management of Anterior Cruciate Ligament Injuries in Skeletally Immature Individuals

“…Moksnes et al 82 reported 3 medial (11%) and 3 lateral (11%) meniscus injuries in 26 children during a follow-up period of 2 to 9 years, while Mizuta et al 80 reported 1 additional meniscus injury in a study of 18 skeletally immature patients (6%). Graf et al 40 reported 7 new meniscus injuries (88%) in 8 children who underwent delayed ACL reconstruction due to knee instability. Although the methodological quality of these studies must be taken into consideration, 3 of 4 studies did not show a high incidence of secondary meniscus injuries in nonoperatively treated children.…”

“…In studies on primary nonoperative treatment, the rehabilitation programs are insufficiently described. 40,80,82,107 There seems to be a consensus on the use of a knee brace during sports activities, although no RCT has been published that studies bracing and ACL injuries in children. Woods and O'Connor 107 followed the strictest algorithm, recommending bracing and activity limitations until surgical treatment at skeletal maturity, while Mizuta et al 80 and Moksnes et al 82 advocated bracing only when performing pivoting sports.…”

Knieverletzungen im Wachstumsalter

“…Die Rate der Wiederaufnahme sportlicher Aktivität war nach konservativer Therapie eher gering (5-41%; [38] [1,4,12,20,21,29]. Nur oder fast nur konservative Behandlungen wurden in 4 der 10 Studien beschrieben [10,14,27,44].…”