Intraarticular stabilization after anterior cruciate ligament tear in children and adolescents: results 6 years after surgery

Abstract

Tear of the anterior cruciate ligament (ACL) secondary to knee sprain injury is also quite common among children and adolescents. Whether reconstruction is indicated and which technique should be employed is still controversial. The debate focuses on the possible risk of growth plate damages due to intraarticular operative reconstruction techniques. For more details on benefit and risks of operative stabilization, our clinic's large number of surgical results was to be evaluated retrospectively. In a total of 437 knee joint arthroscopies performed between 1982 and 1992 in children and adolescents with open physes, aged 3-16 years, 63 surgical repair/reconstructions according to an algorithm were carried out. The average age at surgery was 13.8 years. Follow-up an average 6.5 years after the operation consisted of clinical and radiological examination, Lysholm, Tegner, and IKDC scores. This report focuses on intraarticular ligament reconstruction methods. Forty-four patients could be followed up, comprising of five reinsertions, ten internal fixations, 15 cases semitendinosus tendon (ST) augmentations, and 14 primary reconstructions with the middle one-third of the patellar tendon (PT). In every ST and PT case, transtibial and transfemoral tunnels were drilled. The clinical stability examination was supplemented by KT-1000 arthrometer measurements and radiography in two planes. Averaged for all surgical techniques, good and very good results were obtained in over 75% of cases. There were no major growth defects and rarely signs of osteoarthrosis. According to literature, conservative treatment of ACL tears and even primary ACL repair is not infrequently followed by re-ruptures. Therefore, reconstruction is the preferred procedure for patients aged 12 years or more. As most authors hesitate to possibly block the physes by obtaining and anchoring patellar tendon grafts, the ST should be preferred. This study demonstrates in a large number of ACL stabilizations, despite transepiphyseal drilling and grafting, very good stabilization is achieved, but no growth defects have to be expected.

Primary Repair of the Anterior Cruciate Ligament: A Systematic Review

“…[16][17][18][19] Arbes et al 16 reported on a mixed cohort of 63 patients, of whom only 20 were available for follow-up and only 3 underwent primary repair of the ACL. Of these 3 patients, 2 ultimately underwent ACL reconstruction.…”

Pediatric anterior cruciate ligament reconstruction

“…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.…”

Anterior cruciate ligament tears in children

“…Gaulrapp et al [26], over a ten-year period (1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992), carried out 457 arthroscopies in children aged 3 to 16. They found 20% of ACL injuries, percentage similar to that found by Kellenberger and Von Laer [27].…”