Anterior Cruciate Ligament Tears in Children: An Analysis of Operative Versus Nonoperative Treatment

Pressman, Ari; Letts, R. Merv; Jarvis, James

doi:10.1097/01241398-199707000-00019

Cited by 85 publications

(82 citation statements)

References 23 publications

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“…Pressman et al reported on 16 children treated nonoperatively by primary repair or by intra-articular ACL reconstruction [21]. ACL reconstruction resulted in the best outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the documentation of ACL injuries in skeletally immature patients has significantly increased during the past decade [1-5, 7, 8, 10-12, 16, 19, 21, 23, 24]. Non-reconstructive treatment often leads to poor results, especially concerning sports activity and further meniscal and chondral injuries [20,21]. Many surgical treatment options have been introduced, including primary repair and reconstruction, using both extra-articular as well as intraarticular procedures.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…Pressman et al reported on 16 children treated nonoperatively by primary repair or by intra-articular ACL reconstruction [21]. ACL reconstruction resulted in the best outcome.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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

View full text Add to dashboard Cite

show abstract

“…The natural history of nonoperative treatment of this injury is poor with chronic instability leading to chondral and meniscal injuries [1,16,20,28,31,32,35]. However, traditional surgical stabilization, with grafts placed through tunnels drilled across the physis, risks iatrogenic damage to the physis, which may produce a growth disturbance.…”

Section: Introductionmentioning

confidence: 96%

All-epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients

Lawrence

Bowers

Belding

et al. 2010

Clinical Orthopaedics &Amp; Related Research

152

140

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“…Several studies reported failure of ACL conservative treatment in the skeletally immature patients [1,28,34]. In the literature, a consensus seems to exist for surgical treatment but ACL reconstruction remains a controversial issue.…”

Section: Introductionmentioning

confidence: 99%

Rupture of the anterior cruciate ligament in children: early reconstruction with open physes or delayed reconstruction to skeletal maturity?

Henry¹,

Chotel²,

Chouteau³

et al. 2009

Knee Surg Sports Traumatol Arthrosc

199

136

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The purpose of this study was to compare two different strategies of management for ACL rupture in skeletally immature patient. In group 1, patients were treated in a children hospital by ACL reconstruction with open physis. In group 2, patients were treated in an adult hospital by delayed reconstruction at skeletal maturity assessed radiologically. Fifty-six consecutive patients were included in this retrospective study. Mean time from injury to surgery in group 1 and 2 was, respectively, 13.5 and 30 months. Patients from group 2 exhibited a higher rate of medial meniscal tears (41%) compare to group 1 (16%) and higher rate of meniscectomy. Both groups had the same rate of lateral meniscal tears. A temporary tibial valgus deformity was reported which was subsequently spontaneously resolved. No definitive growth disturbance was noticed. At 27 months mean follow-up, a best subjective IKDC score was found in group 1. Objective IKDC and radiological results were similar in both groups. Early ACL reconstruction is therefore a recommended option.

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Anterior Cruciate Ligament Tears in Children: An Analysis of Operative Versus Nonoperative Treatment

Cited by 85 publications

References 23 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

All-epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients

Rupture of the anterior cruciate ligament in children: early reconstruction with open physes or delayed reconstruction to skeletal maturity?

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