Pediatric Anterior Cruciate Ligament Reconstruction

Perkins, Crystal; Willimon, S. Clifton

doi:10.1016/j.ocl.2019.08.009

Cited by 42 publications

(47 citation statements)

References 60 publications

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“…However, knee extensor recovery time is not the only factor to be considered when selecting the graft type to be used in ACLR. In addition to surgeon preference, patient age and skeletal maturity are important considerations in surgical management due to the potential for growth disturbance in skeletally immature patients [ 3 , 7 , 27 ]. IT grafts are typically used for the youngest patients, who have the greatest remaining growth, and are combined with physis-avoiding techniques [ 7 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…IT grafts are typically used for the youngest patients, who have the greatest remaining growth, and are combined with physis-avoiding techniques [ 7 , 9 ]. As patients mature, preferred treatment progresses to HT or QT soft tissue grafts with physis-respecting transphyseal or partial transphyseal fixation [ 7 , 27 ]. Skeletally mature patients or those with little growth remaining usually undergo traditional adult-type reconstruction with PT, QT, or HT grafts [ 3 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…As patients mature, preferred treatment progresses to HT or QT soft tissue grafts with physis-respecting transphyseal or partial transphyseal fixation [ 7 , 27 ]. Skeletally mature patients or those with little growth remaining usually undergo traditional adult-type reconstruction with PT, QT, or HT grafts [ 3 , 27 ]. Previous studies have indicated good clinical results for IT band ACLR [ 6 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

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Iliotibial Band Autograft Provides the Fastest Recovery of Knee Extensor Mechanism Function in Pediatric Anterior Cruciate Ligament Reconstruction

Wren

Beltran

Katzel

et al. 2021

IJERPH

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Iliotibial band autograft is an increasingly popular option for pediatric anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to compare recovery of knee extensor mechanism function among pediatric patients who underwent ACLR using iliotibial band (IT), hamstring tendon (HT), quadriceps tendon (QT), and patellar tendon (PT) autografts. One hundred forty-five pediatric athletes (76 female; age 15.0, range 7–21 years) with recent (3–18 months) unilateral ACLR performed drop-jump landing and 45° cutting with 3D motion capture. Knee extensor mechanism function (maximum knee flexion angle, maximum internal knee extensor moment, energy absorption at knee) during the loading phase (foot contact to peak knee flexion) was compared among graft types (20 IT, 29 HT, 39 QT, 57 PT) and sides (ACLR or contralateral) using linear mixed models with sex, age, and time since surgery as covariates. Overall, knee flexion was significantly lower on the operated vs. contralateral side for HT, QT, and PT during both tasks (p < 0.03). All graft types exhibited lower knee extensor moments and energy absorption on the operated side during both movements (p ≤ 0.001). Kinetic asymmetry was significantly lower for IT compared with QT and PT during both movements (p ≤ 0.005), and similar patterns were observed for HT vs. QT and PT (p ≤ 0.07). Asymmetry was similar between IT and HT and between QT and PT. This study found that knee extensor mechanism function recovers fastest in pediatric ACLR patients with IT autografts, followed by HT, in comparison to QT and PT, suggesting that IT is a viable option for returning young athletes to play after ACLR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Iliotibial Band Autograft Provides the Fastest Recovery of Knee Extensor Mechanism Function in Pediatric Anterior Cruciate Ligament Reconstruction

Wren

Beltran

Katzel

et al. 2021

IJERPH

View full text Add to dashboard Cite

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“…Additionally, it remains unclear whether tibial spine injury predisposes patients to subsequent ACL injury because they occur at a rate of 14 per 100,000 exposures, representing 19% of knee injuries, in high school athletes. 27 In contrast, tibial spine injuries occur at a rate of 3 per 100,000 children per year, representing 2% to 5% of pediatric knee injuries. 28 Of primary interest in this study was the incidence of contralateral knee injury.…”

Section: Discussionmentioning

confidence: 99%

Tibial Spine Repair in the Pediatric Population: Outcomes and Subsequent Injury Rates

Quinlan

Hobson

Mortensen

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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To evaluate short-to mid-term outcomes after arthroscopic operative fixation of tibial spine fractures in pediatric patients, to determine the incidence of further ipsilateral and contralateral knee injuries, and to describe associated meniscal pathology and intraoperative findings at the time of tibial spine repair. Methods: All patients under age 18 with a tibial spine fracture treated arthroscopically at 1 institution by 2 surgeons from 2008 through 2019 were identified by Current Procedural Terminology codes. Patients at least 1 year from their date of surgery were contacted to complete a questionnaire, which included the International Knee Documentation Committee (IKDC) form. Questions pertained to knee function, pain, and further injury or surgery on either knee. Patient charts, preoperative imaging, and operative reports were reviewed to determine demographic information, tibial spine fracture type, concomitant injuries, and intraoperative details. Results: Sixty-six of 97 eligible patients (68%) completed questionnaires. Average age at initial surgery was 10.7 years (range, 4-17). Mean follow-up was 5.8 years (range, 1.0-11.9). Average IKDC score at follow-up was 91.4 (range, 62.1-100). Patients reported their knee as 92% of "normal" (range, 40-100). Thirty-five (53%) currently participate in sport; 6 (9%) remain limited because of instability and residual pain. Regarding pain on a visual analog scale, 94%, 95%, and 83% of patients reported less than a 3 at rest, with daily activity, and with sport, respectively. Seven patients (11%) had subsequent ACL rupture. Six patients (9%) underwent ACL reconstruction 3.1 years (range, 0.9-7) after initial repair. Fourteen patients (21%) required at least 1 additional procedure. Regarding the contralateral knee, there were no ACL or tibial spine injuries. Sixty-one (92%) patients were both satisfied and would definitely undergo the procedure again. Conclusions: Although many pediatric patients demonstrate excellent results after tibial spine repair at mean 5.8 years follow-up, 10.6% sustained an ipsilateral ACL rupture, and 21% required an additional procedure. No patient had a contralateral tibial spine or ACL injury. This is helpful when counseling patients regarding injury risk when returning to activity after tibial spine repair. Level of Evidence: Level IV, therapeutic case series.

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“…The exact age and sex distribution among our subjects could not be retrieved due to a strict anonymization protocol. The presence of open epiphysis can influence the choice of treatment in ACL injury [ 14 ]. Whether the age of the subjects influences an observer’s performance to determine the femoral footprint of the ACL is unknown.…”

Section: Discussionmentioning

confidence: 99%

Intra-and interobserver reliability of determining the femoral footprint of the torn anterior cruciate ligament on MRI scans

Zee

Sulaihem

Diercks

et al. 2021

BMC Musculoskelet Disord

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Background Re-injury rates following reconstruction of the anterior cruciate ligament (ACL) are significant; in more than 20% of patients a rupture of the graft occurs. One of the main reasons for graft failure is malposition of the femoral tunnel. The femoral origin of the torn ACL can be hard to visualize during arthroscopy, plus many individual variation in femoral origin anatomy exists, which may lead to this malpositioning. To develop a patient specific guide that may resolve this problem, a preoperative MRI is needed to identify the patient specific femoral origin of the ACL. The issue here is that there may be a difference in the reliability of identification of the femoral footprint of the ACL on MRI between different observers with different backgrounds and level of experience. The purpose of this study was to determine the intra- and interobserver reliability of identifying the femoral footprint of the torn ACL on MRI and to compare this between orthopedic surgeons, residents in orthopedic surgery and MSK radiologists. Methods MR images of the knee joint were collected retrospectively from 20 subjects with a confirmed rupture of the ACL. The 2D (coronal, sagittal, transversal) proton-density (PD) images were selected for the segmentation procedure to create 3D models of the femurs. The center of the femoral footprint of the ACL on 20 MRI scans, with visual feedback on 3D models (as reference) was determined twice by eight observers. The intra- and interobserver reliability of determining the center of the femoral footprint on MRI was evaluated. Intraclass correlation coefficients (ICCs) were calculated for the X, Y and Z coordinates separately and for a 3D coordinate. Results The mean 3D distance between the first and second assessment (intraobserver reliability) was 3.82 mm. The mean 3D distance between observers (interobserver reliability) was 8.67 mm. ICCs were excellent (> 0.95), except for those between the assessments of the two MSK radiologists of the Y and Z coordinates (0.890 and 0.800 respectively). Orthopedic surgeons outscored the residents and radiologists in terms of intra- and interobserver agreement. Conclusion Excellent intraobserver reliability was demonstrated (< 4 mm). However the results of the interobserver reliability manifested remarkably less agreement between observers (> 8 mm). An orthopedic background seems to increase both intra- and interobserver reliability. Preoperative planning of the femoral tunnel position in ACL reconstruction remains a surgical decision. Experienced orthopedic surgeons should be consulted when planning for patient specific instrumentation in ACL reconstruction.

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Pediatric Anterior Cruciate Ligament Reconstruction

Cited by 42 publications

References 60 publications

Iliotibial Band Autograft Provides the Fastest Recovery of Knee Extensor Mechanism Function in Pediatric Anterior Cruciate Ligament Reconstruction

Iliotibial Band Autograft Provides the Fastest Recovery of Knee Extensor Mechanism Function in Pediatric Anterior Cruciate Ligament Reconstruction

Tibial Spine Repair in the Pediatric Population: Outcomes and Subsequent Injury Rates

Intra-and interobserver reliability of determining the femoral footprint of the torn anterior cruciate ligament on MRI scans

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