Growth Abnormalities Following Anterior Cruciate Ligament Reconstruction in the Skeletally Immature Patient: A Systematic Review

Collins, Michael J.; Arns, Thomas A.; Leroux, Timothy; Black, Austin; Mascarenhas, Randhir; Bach, Bernard R.; Forsythe, Brian

doi:10.1016/j.arthro.2016.02.025

Cited by 70 publications

(74 citation statements)

References 37 publications

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“…Open physes (previously rated as a factor that was not important for recommendation of ACL-R according to American orthopaedic surgeons [19]) was in the present study rated as important by 43% of orthopaedic surgeons, and by 20% of physical therapists. The potential for growth abnormality or growth arrest following ACL-R in children with open physes is debated, and consequently, there is strong debate about whether ACL-R is indicated or not [3, 5]. Open physes was among the factors with the highest disagreement among orthopaedic surgeons, which could reflect this uncertainty.…”

Section: Discussionmentioning

confidence: 99%

Activity demands and instability are the most important factors for recommending to treat ACL injuries with reconstruction

Grevnerts

Fältström

Sonesson

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of the study was to (1) study and compare the factors that Swedish orthopaedic surgeons and physical therapists consider important for recommending ACL reconstruction and, (2) to assess how orthopaedic surgeons and physical therapists consider their own and each others, as well as patients’, roles are in the treatment decision.MethodsA web-based survey assessing the relevance of 21 predetermined factors, in the choice to recommend ACL reconstruction, was sent to orthopaedic surgeons and physical therapists. Respondents were also asked to rate the importance of the assessment made by themselves, the other clinician (physical therapists rated the importance of surgeons, surgeons rated the importance of physical therapists), and the patients’ preferences.ResultOrthopaedic surgeons agreed of eight, and physical therapists of seven factors as important in the choice to recommend ACL reconstruction. The factors both groups reported as important were; “patient’s wishes to return to contact/pivoting sports”, “instability in physical activity”, “instability in activities of daily living despite adequate rehabilitation”, “physically demanding occupation”, and “young age”. Both professions rated their own and each others assessments as well as patient’s wishes as important for the decision to recommend ACL reconstruction.ConclusionOrthopaedic surgeons and physical therapists agree about factors that are important for their decision to recommend ACL reconstruction, showing that both professions share a common ground in perceptions of factors that are important in recommending ACL reconstruction.Level of evidenceDiagnostic study: Level III.Electronic supplementary materialThe online version of this article (10.1007/s00167-018-4846-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Activity demands and instability are the most important factors for recommending to treat ACL injuries with reconstruction

Grevnerts

Fältström

Sonesson

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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“…A study of Holwein et al [21] reported that transphyseal ACL reconstruction with metaphyseal fixation in children with open growth plates can be done with low risk of growth changes, and return to competitive sports is possible although low rotational laxity still exists. However the study of Collins et al [22] reported that growth abnormalities after ACL reconstruction in the skeletally immature patient are underreported, and our current understanding of the etiology of these abnormalities is limited.…”

Section: Discussionmentioning

confidence: 99%

Review and Long-Term Outcomes of Cruciate Ligament Reconstruction versus Conservative Treatment in Siblings with Congenital Anterior Cruciate Ligament Aplasia

Davanzo¹,

Fornaciari

Barbier³

et al. 2017

Case Reports in Orthopedics

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There is no consensus on the best treatment for anterior cruciate ligament hypoplasia or aplasia. To our knowledge, no comparative study between operative and conservative treatment of this condition has ever been performed. Conservative treatment is a viable alternative to surgery for ACL aplasia. Two siblings were examined at our outpatient clinic. The male patient underwent bilateral ACL reconstruction, while his sister was treated conservatively. Our results show a worse long-term outcome for the operative patient. At her last follow-up, the female patient treated conservatively showed subjective improvement in stability and gait. A review of the literature shows inconsistent outcomes after reconstruction in contrast to reports with cruciate ligament agenesis that did not undergo reconstruction with acceptable to good outcomes. Cruciate reconstruction should be reserved for cases of impaired articular instability, objectively manifest in the frequency of giving-way episodes. Treatment depends on the patient's condition and expectations. Surgery should therefore only be suggested after proper patient counseling.

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“…The defect created in our study does not closely recapitulate the most common types of injury seen in the clinic, yet it does bear similarities to Salter Harris Type IV physeal injuries and to the disruption to the growth plate and epiphyseal bone caused during transphyseal fixation methods for surgical reconstruction of the anterior cruciate ligament and for tibial eminence fractures. As with physeal injuries, this surgical approach raises concern for disruption of bone growth [54]. Moreover, hole defects have been used often to study formation of bone bridges in animal models [7,14].…”

Section: Discussionmentioning

confidence: 99%

Local Changes to the Distal Femoral Growth Plate Following Injury in Mice

Drenkard

Kupratis

et al. 2017

Journal of Biomechanical Engineering

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Injury to the growth plate is associated with growth disturbances, most notably premature cessation of growth. The goal of this study was to identify spatial changes in the structure and composition of the growth plate in response to injury to provide a foundation for developing therapies that minimize the consequences for skeletal development. We used contrast-enhanced microcomputed tomography (CECT) and histological analyses of a murine model of growth plate injury to quantify changes in the cartilaginous and osseous tissue of the growth plate. To distinguish between local and global changes, the growth plate was divided into regions of interest near to and far from the injury site. We noted increased thickness and CECT attenuation (a measure correlated with glycosaminoglycan (GAG) content) near the injury, and increased tissue mineral density (TMD) of bone bridges within the injury site, compared to outside the injury site and contralateral growth plates. Furthermore, we noted disruption of the normal zonal organization of the physis. The height of the hypertrophic zone was increased at the injury site, and the relative height of the proliferative zone was decreased across the entire injured growth plate. These results indicate that growth plate injury leads to localized disruption of cellular activity and of endochondral ossification. These local changes in tissue structure and composition may contribute to the observed retardation in femur growth. In particular, the changes in proliferative and hypertrophic zone heights seen following injury may impact growth and could be targeted when developing therapies for growth plate injury.

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Growth Abnormalities Following Anterior Cruciate Ligament Reconstruction in the Skeletally Immature Patient: A Systematic Review

Cited by 70 publications

References 37 publications

Activity demands and instability are the most important factors for recommending to treat ACL injuries with reconstruction

Activity demands and instability are the most important factors for recommending to treat ACL injuries with reconstruction

Review and Long-Term Outcomes of Cruciate Ligament Reconstruction versus Conservative Treatment in Siblings with Congenital Anterior Cruciate Ligament Aplasia

Local Changes to the Distal Femoral Growth Plate Following Injury in Mice

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