The natural history and treatment of rupture of the anterior cruciate ligament in children and adolescents

Aichroth, Paul; Patel, Dipak V.; Zorrilla, Pedro

doi:10.1302/0301-620x.84b1.0840038

Cited by 195 publications

(147 citation statements)

References 16 publications

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“…Only 7 patients returned to sports, and all 16 patients experienced giving way, effusions and pain. Aichroth et al [2] reported on 23 patients who were treated conservatively and had results of severe instability and poor functional outcome. This has been our experience, too: Half (four) of the patients treated conservatively reduced their sports activity, and when examined on follow-up, seven patients showed a positive Lachman without a firm endpoint.…”

Section: Discussionmentioning

confidence: 99%

The functional outcome of total tears of the anterior cruciate ligament (ACL) in the skeletally immature patient

Arbes

Resinger

Vécsei

et al. 2006

International Orthopaedics (SICO

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Tears of the anterior cruciate ligament (ACL) in the skeletally immature patient are becoming more prevalent. The aim of this study was to describe the functional outcome and to evaluate the best management of total tears of the ACL in skeletally immature patient. Twenty consecutive, skeletally immature patients with a clinically evident rupture of the anterior cruciate ligament were followed up for a mean of 5.4 years. The mean age at the time of injury was 13.9 years old. The study group consisted of 13 girls and 7 boys, who were treated either conservatively, by ACL reconstruction, by primary repair or by delayed ACL reconstruction after skeletal maturity had been reached. Clinical outcomes were measured using the International Knee Documentation Committee Scoring System (IKDC) and the Knee Injury and Osteoarthritis Outcome Scoring System (KOOS). The radiological evaluation was performed using Jaeger and Wirth's criteria, and instrumented laxity testing was carried out with a Rolimeter. Five of the eight patients treated conservatively showed poor function of the knee, and this resulted in instability. Concerning the patients treated by primary repair, delayed ACL reconstruction or arthroscopic debridement, we also found none of the results to be satisfactory (seven of eight patients). The patients that were treated by a reconstruction had the best results. This was confirmed by clinical examination (Lachmann grade 1), by the IKDC (grade B) and by the KOOS with the best quality of life and no giving-way attacks. The level of evidence was therapeutic level III. Résumé Les ruptures du ligament croisé antérieur chez des jeunes patients qui ne sont pas encore à maturité osseuse deviennent de plus en plus nombreuses. Le but de cette étude est de décrire l'avenir fonctionnel et d'évaluer le meilleur traitement de ces ruptures du croisé antérieur chez des sujets au squelette immature. Vingt patients consécutifs en cours de croissance ayant présenté de façon évidente sur le plan clinique une rupture du ligament croisé antérieur ont été suivis sur une moyenne de 5,4 ans. L'âge moyen au moment du traumatisme était de 13,9 ans. Le groupe étudié consiste en 13 filles et 7 garçons qui ont tous été traités par reconstruction du ligament croisé antérieur de façon immé-diate ou, par reconstruction secondaire après fermeture du cartilage de croissance. L'avenir clinique des patients a été étudié selon le score de l'IKDC et du KOOS. L'étude radiologique a utilisée les critères de Jaeger et de Wirth et la laxité a été mesurée avec un Rolimeter. Les patients ont été traités soit par réparation immédiate du ligament croisé antérieur soit par réparation secondaire. Cinq patients (62.5%) traités de façon orthopédique ont montré un résultat clinique médiocre avec une instabilité résiduelle. Les patients traités par réparation primaire ou secondaire du ligament croisé antérieur avec reconstruction ou nettoyage sous arthroscopie non, également pas eu de résultats satisfaisants pour sept d'entre-eux (87.5%). Les patients qui o...

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Section: Discussionmentioning

confidence: 99%

The functional outcome of total tears of the anterior cruciate ligament (ACL) in the skeletally immature patient

Arbes

Resinger

Vécsei

et al. 2006

International Orthopaedics (SICO

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“…We classified non-operated subjects as copers at the follow-up examination if they (1) had resumed their pre-injury activity level, and (2) performed single legged hop test indexes ≥90% of the uninjured limb. Subjects who failed any of these two criteria were classified as non-copers at follow-up.…”

Section: Materials a D Methodsmentioning

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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“…Many children find it difficult to modify recreational activities sufficiently to avoid instability episodes. Aichroth et al [8] attempted to manage 33 children and adolescents with a mean age of 12.5 years with rehabilitation, bracing and activity modification. Ten of the children required stabilization due to increasing instability.…”

Section: Natural History Of the Acl Deficient Kneementioning

confidence: 99%

“…A number of series' report transphyseal ACL reconstructions using a variety of grafts and fixation devices with good outcomes in pediatric patients and little risk of growth disturbance [8,10,[50][51][52][53][54][55], [56•], [57], [58•]. Aronowitz et al [50] used Achilles tendon allograft with 9-10 mm tunnels in patients with a skeletal age of at least 14.…”

Section: Transphyseal Techniquesmentioning

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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The natural history and treatment of rupture of the anterior cruciate ligament in children and adolescents

Cited by 195 publications

References 16 publications

The functional outcome of total tears of the anterior cruciate ligament (ACL) in the skeletally immature patient

The functional outcome of total tears of the anterior cruciate ligament (ACL) in the skeletally immature patient

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

Pediatric anterior cruciate ligament reconstruction

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