Anterior Cruciate Ligament Injuries in Skeletally Immature Patients

Abstract

Twenty-eight consecutive, skeletally immature patients (9.9-15.0 years of age at the time of injury) with total rupture of the anterior cruciate ligament (ACL) were followed up for 3-5 years. The aims of the study were to monitor the natural course of conservative treatment, to identify variables relevant to failure of conservative treatment, and to evaluate an over-the-top procedure for ACL reconstruction by using the semitendinosus tendon and avoiding the physes. The patients were interviewed according to Lysholm knee score and Tegner activity level. Knee laxity and muscle torque were measured. Five patients insisted on immediate reconstruction. Twenty-three patients were sent to a 3-month rehabilitation program. Sixty-eight percent of the patients, who made an attempt with conservative treatment, had been operated on at follow-up. The patients not operated on were younger at injury and had a lower activity level at follow-up. The surgical procedure improved objective and subjective knee function, but there was a correlation between high activity level and a low Lysholm score.

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

“…Our median Lysholm score of 88 points is equivalent to Janarv et al [26] who reported average 87 points on the Lysholm score. A high proportion of non-operated subjects (65%) had resumed their preinjury activity level, indicating that most children had confidence in their knee function and were able to participate in free and regular activities.…”

“…In the present study the percentage of children who resumed pre-injury activity level was lower among children who originally participated in level 1 activities, than those who participated in level 2 activities. 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.…”

“…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.…”

Pediatric ACL injuries: evaluation and management

“…Instead, bracing, activity modification, and physical therapy were used with satisfactory short term results [32][33][34]. However, more recent reports of increased risk of subsequent surgery for meniscal and chondral pathology has shifted this paradigm [34][35][36]. Still more studies have shown that nonoperative treatment of ACL injuries can lead to chronic instability and poor outcomes, with fewer athletes able to return to their sport at the same or higher level than in those undergoing reconstruction [35,37].…”

“…Many operative treatment options have been described for these fractures, including open [36,74] or arthroscopic [42,43] reduction and casting and open [36,75,76] or arthroscopic [77,78] reduction and fixation. Fixation can be performed with sutures [77][78][79][80][81], (Fig.…”