Delayed Anterior Cruciate Ligament Reconstruction in Adolescents with Open Physes

Woods, G. William; O’Connor, Daniel P.

doi:10.1177/0363546503258868

Cited by 124 publications

(83 citation statements)

References 36 publications

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“…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. Woods and O'Connor [28] employed a protocol to delay reconstruction that included rehabilitation, absolute avoidance of pivoting activities and full time brace wear while awake. Compared to a control group who received acute reconstructions, they reported no increase in intra-articular injuries despite a mean delay of 70 weeks until ACL reconstruction.…”

Section: Non-operative Treatmentmentioning

confidence: 99%

Pediatric anterior cruciate ligament reconstruction

McConkey

Bonasia

Amendola³

2011

Curr Rev Musculoskelet Med

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An increasing number of anterior cruciate ligament (ACL) injuries are seen in children now than in the past due to increased sports participation. The natural history of ACL deficient knees in active individuals, particularly in children is poor. Surgical management of ACL deficiency in children is complex due to the potential risk of injury to the physis and growth disturbance. Delaying ACL reconstruction until maturity is possible but risks instability episodes and intra-articular damage. Surgical options include physeal-sparing, partial transphyseal and complete transphyseal procedures. This article reviews the management of ACL injured skeletally immature patients including the functional outcome and complications of contemporary surgical techniques.

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Section: Non-operative Treatmentmentioning

confidence: 99%

Pediatric anterior cruciate ligament reconstruction

McConkey

Bonasia

Amendola³

2011

Curr Rev Musculoskelet Med

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“…The variability in return to sport rates among non-operated ACL injured children is high [26,36]. Janarv et al [26] from Sweden reported that 88% of their non-operated children were performing activities at their desired activity level, McCarrol et al [36] described that 42% attempted to return to sport after conservative treatment (all failed), while no children in Woods & O'Connors [52] study continued at their pre-injury activity level, due to the restrictions in their treatment algorithm. There seems to be a difference in the return to sport rates after non-operative treatment between the Scandinavian countries and the USA, although the materials are small not directly comparable.…”

Section: Discussiomentioning

confidence: 99%

Performance-based functional outcome for children 12 years or younger following anterior cruciate ligament injury: a two to nine-year follow-up study

Moksnes

Engebretsen

Risberg

2007

Knee Surg Sports Traumatol Arthr

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There is limited scientific knowledge on ACL injuries in children 12 years or younger. Substantial controversy exists on treatment algorithms and there are no published data on performance-based functional outcome. Classification of adult ACL injured subjects as copers and non-copers is common, but no study has classified knee function in children using performance-based functional test after ACL injury. The aim of the present study was to evaluate the medium-term functional outcome among children with ACL injury and to classify them as copers and noncopers. Children 12 years or younger who were referred to our institution from 1996 to 2004 with an ACL injury were included. Twenty non-operated subjects (21 knees) and six ACL reconstructed subjects (7 knees) were examined at a minimum of 2 years after ACL injury or reconstruction. Four single-legged hop tests, isokinetic muscle strength measurements, and three functional questionnaires (IKDC 2000, KOS-ADLS and Lysholm) were used as outcome measurements. Children who had resumed their pre-injury activity level and performed above 90% on all hop tests were classified as copers following non-operative treatment and ACL reconstruction. The 26 children were on average 10.1 years at the time of injury. Of the non-operated children, 65% had returned to pre-injury activity level, and 50% were classified as copers. Copers scored significantly better than non-copers on single hop for distance, IKDC 2000, and Lysholm score. Of the non-operated children, 9.5% had suffered a secondary meniscus injury. Of the ACL reconstructed subjects, 67% were classified as copers at follow-up. Non-operated ACL-deficient children demonstrated excellent knee function on performance-based single-legged hop tests and 65% had returned to pre-injury activity level. Delayed ACL reconstruction resulted in success for a majority of the ACL-reconstructed children. Treatment algorithms for ACL-injured children are discussed.

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“…Making an accurate diagnosis can be difficult as there is a spectrum of injuries including tibial avulsions, partial ACL tears, and complete tears, and there can be multiple barriers to performing an accurate examination in this patient population. Also, there is some controversy over the appropriate treatment of these injuries in the pediatric and adolescent patient, mostly out of concern for the physis and potential growth disturbances [4,[7][8][9]. If surgery is chosen, there is debate over the appropriate technique as well as graft choice.…”

Section: Introductionmentioning

confidence: 99%

Pediatric ACL injuries: evaluation and management

Mall¹,

Paletta

2013

Curr Rev Musculoskelet Med

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The anterior cruciate ligament (ACL) is a stabilizing structure to both anterior translation of the tibia with respect to the femur as well as rotation of the knee joint. Children and adolescents are susceptible to these injuries, and there are some who believe the incidence of ACL injuries in this population is increasing due to year round single sport participation. Pediatric ACL injuries are typically seen in several forms: tibial avulsion fractures, partial ACL tears, and full thickness ligament tears. There were and still are some who feel that ACL injuries should be treated non-operatively in the pediatric and adolescent population; however, recent literature refutes this notion. Several factors must be considered during pediatric and adolescent ACL reconstruction, each of which will be examined in this manuscript, including: status of the physis, reconstruction technique, and graft source.

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Delayed Anterior Cruciate Ligament Reconstruction in Adolescents with Open Physes

Cited by 124 publications

References 36 publications

Pediatric anterior cruciate ligament reconstruction

Pediatric anterior cruciate ligament reconstruction

Performance-based functional outcome for children 12 years or younger following anterior cruciate ligament injury: a two to nine-year follow-up study

Pediatric ACL injuries: evaluation and management

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