Micheli Anterior Cruciate Ligament Reconstruction in Skeletally Immature Youths

Willimon, S. Clifton; Jones, Christopher R.; Herzog, Mackenzie M.; May, Keith H.; Leake, Melissa J.; Busch, Michael T.

doi:10.1177/0363546515608477

Cited by 62 publications

(61 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A pediatric-specific PROM, the Pediatric International Knee Documentation Committee (Pedi-IKDC) subjective knee form, 26 was reported in 1 of the 17 studies. 48 …”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Outcome Reporting in Youth ACL Literature Is Widely Variable

Brusalis

Lakomkin

Suryavanshi

et al. 2017

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background:Advances in anterior cruciate ligament (ACL) reconstruction procedures in pediatric and adolescent patients have resulted in an increase in recent clinical studies on this topic. However, the consistency with which outcome measures are reported in this demographic is unknown.Purpose:To document outcome reporting patterns of youth ACL reconstruction studies in high-impact journals.Study Design:Systematic review; Level of evidence, 4.Methods:All articles published in 5 high-impact orthopaedic journals from 2010 to 2016 were reviewed to identify those reporting clinical outcomes of young patients who underwent ACL reconstruction. Studies that were nonclinical, reported on patients older than 18 years, or included fewer than 10 patients were excluded. Outcome measures used in all included studies were recorded.Results:Seventeen studies encompassing 772 subjects (mean age, 14.3 years; range, 6.3-18.0 years) were analyzed. Eight studies (47%) reported on Tanner stage of subjects, while 1 study reported skeletal age. Ten studies (59%) clearly documented the presence or absence of surgical complications. Range of motion was reported in 65% of studies. Leg-length discrepancy and angular deformity were each reported in 76% of studies, with 12% quantifying results through radiographic measurements. Ligament testing was variably defined by inclusion of instrumented testing (65%), Lachman test (53%), and pivot-shift test (53%). Fourteen studies (82%) explicitly reported on the rate of ACL rerupture, while 71% reported on the rate of revision surgery. Rate of return to preinjury activity was reported in 8 studies (47%), of which 2 defined criteria for return to sport and 3 defined the level of competitive sport. Patient-reported outcome measures (PROMs) were used variably. For the 3 most commonly reported PROMs (Lysholm, International Knee Documentation Committee, and Tegner), 24% of studies reported all 3 PROMs, 35% of studies reported 2 PROMs, and 6% of studies reported 1 PROM in isolation. A pediatric-specific PROM was reported in 1 of the 17 studies.Conclusion:Studies on pediatric ACL reconstruction published in high-impact journals unreliably defined subjects’ skeletal maturity, inconsistently reported on objective outcome measures, and used disparate adult-validated PROMs to assess subjective outcomes. These findings highlight the need for standardized, pediatric-specific outcome measures to be applied in future studies evaluating ACL reconstruction in children and adolescents.

show abstract

“…A pediatric-specific PROM, the Pediatric International Knee Documentation Committee (Pedi-IKDC) subjective knee form, 26 was reported in 1 of the 17 studies. 48 …”

Section: Resultsmentioning

confidence: 99%

“… 39 That said, only 1 study from our sample incorporated a pediatric-specific, validated instrument. 48 Recently developed pediatric-focused knee and activity PROMs may have a widespread impact if appropriately used for future clinical outcomes assessments in this demographic. 16 , 17 , 26 …”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome Reporting in Youth ACL Literature Is Widely Variable

Brusalis

Lakomkin

Suryavanshi

et al. 2017

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

show abstract

“…Pedi-IKDC (Pediatric IKDC) and Lysholm scores averaged 93 points each. Clinical success has been replicated in other series as well 104,105 . Twenty-two knees at a mean follow-up of 3.0 years had mean Pedi-IKDC and Lysholm scores of 96.5 and 95 points, respectively, with high patient satisfaction, no limb-length or angular deformities, and 3 knees (14%) that required revision ACL surgery 105 .…”

Section: Physeal Sparing: Extraphyseal Iliotibial Band Autograft Recomentioning

confidence: 80%

Management of ACL Injuries in Children and Adolescents

Fabricant

Kocher

2017

The Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

ä Children and adolescent athletes constitute the largest demographic of patients who sustain anterior cruciate ligament (ACL) tears, and the frequency is increasing. ä In ACL-deficient children and adolescents, continued symptoms of instability can result in progressive meniscal and cartilage damage as well as arthritic changes. ä Growth disturbance can occur after ACL surgery in children, and includes tibial recurvatum due to tibial tubercle apophyseal arrest as well as limb-length discrepancy and/or angular deformity due to physeal arrest or overgrowth. ä Several "physeal sparing" and "physeal respecting" ACL reconstruction techniques have been developed for use in skeletally immature patients to minimize the risk of growth disturbance, with favorable clinical outcomes. ä ACL injury prevention strategies include neuromuscular conditioning and may be performed to prevent both initial ACL injury as well as reinjury and injury of the contralateral ACL after reconstruction. Disclosure: No internal or external funding was provided for this project. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/B603).

show abstract

“…The rate of ACL graft failure was 4.5%, and no growth disturbances were reported 51,52. Willimon et al57 described similar low graft failure rates with no growth disturbances, adding that patients were successful at return to sports after iliotibial band ACL reconstruction. Despite being a nonanatomic reconstruction, biomechanical studies have shown that it best replicates the intact ACL 58,59.…”

Section: Treatmentmentioning

confidence: 89%

Prevention, treatment, and rehabilitation of anterior cruciate ligament injuries in children

Lang¹,

Sugimoto²,

Micheli³

2017

OAJSM

View full text Add to dashboard Cite

As more children and adolescents participate in competitive organized sports, there has been an increase in the reported incidence of anterior cruciate ligament (ACL) injuries in these age groups. ACL injuries in skeletally immature athletes present a challenge, as reconstruction must preserve the physis of the distal femur and of the proximal tibia to avoid growth disturbances. Historically, a skeletally immature athlete with an ACL injury was treated with a brace and activity modification until skeletal maturity, with ACL reconstruction being performed at that time in the “non-copers” who experienced instability. More recently, evidence has shown that delayed reconstruction may lead to increased damage to the meniscus and articular cartilage. As a result, early reconstruction is favored to protect the meniscus and allow continued physical activity. While adolescents at or those near skeletal maturity may be treated with standard reconstruction techniques, they may result in growth disturbances in younger athletes with significant growth remaining. In response to the growing need for ACL reconstruction techniques in skeletally immature individuals, physeal-sparing and physeal-respecting reconstruction techniques have been developed. In addition to the advancements in surgical technique, ACL injury prevention has also gained attention. This growing interest in ACL prevention is in part related to the high risk of ACL re-tear, either of the ACL graft or of the contralateral ACL, in children and adolescents. Recent reports indicate that well-designed neuromuscular training programs may reduce the risk of primary and subsequent ACL injuries.

show abstract

Micheli Anterior Cruciate Ligament Reconstruction in Skeletally Immature Youths

Cited by 62 publications

References 49 publications

Clinical Outcome Reporting in Youth ACL Literature Is Widely Variable

Clinical Outcome Reporting in Youth ACL Literature Is Widely Variable

Management of ACL Injuries in Children and Adolescents

Prevention, treatment, and rehabilitation of anterior cruciate ligament injuries in children

Contact Info

Product

Resources

About