Outcomes and Risks of Operative Treatment of Rupture of the Anterior Cruciate Ligament in Children and Adolescents

Frosch, Karl‐Heinz; Stengel, Dirk; Brodhun, Tobias; Stietencron, Immanuel von; Holsten, D.; Jung, Christian; Reister, Dominik; Voigt, C.; Niemeyer, Philipp; Maier, Markus; Hertel, P.; Jagodzinski, Michael; Lill, Helmut

doi:10.1016/j.arthro.2010.04.077

Cited by 215 publications

(183 citation statements)

References 83 publications

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“…A recent meta-analysis of the literature included 941 physeal sparing or transphyseal reconstructions and found that the overall incidence of growth abnormalities was 2.1% and rerupture rate was 3.8% [64]. They also reported that physeal-sparing techniques increased risk of growth abnormalities (1.9% versus 5.8%) but cautioned that the uncontrolled nature of the case series' included in the study makes interpretation of the results difficult.…”

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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Section: Transphyseal Techniquesmentioning

confidence: 99%

Pediatric anterior cruciate ligament reconstruction

McConkey

Bonasia

Amendola³

2011

Curr Rev Musculoskelet Med

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“…Studies in adult patients [7,8,24,39] and in pediatric patients [12,28,32] have shown an increased incidence of medial meniscal tears with delayed ACL reconstruction. Although the treatment of ACL tears in skeletally immature patients remains controversial [33], the risk of physeal injury and resulting growth disturbance from ACL repair to a patient with open physes is now thought to be small [15,22], and many centers (including our institution) opt for prompt reconstruction before skeletal maturity [9,16,20,25,31,34,40].…”

Section: Introductionmentioning

confidence: 99%

Meniscal Injury After Adolescent Anterior Cruciate Ligament Injury: How Long Are Patients at Risk?

Guenther

Swami

Dhillon

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Delay of as much as 5 months between ACL injury and surgery is known to be associated with increased risk of a medial meniscal tear, but the risk of additional meniscal tear progression with a longer delay to surgery is unclear. Questions/purposes We determined the (1) times of injury, MRI, and surgery in adolescents with ACL tears, and whether (2) timing of surgery, or (3) initial integrity of the meniscus seen on MR images predicted development of meniscal tears. Methods We reviewed 112 adolescents who were 15 ± 1 years old (mean ± SD) (range, 11-16 years) with a torn ACL. These patients underwent surgical repair from 2005 to 2011 in a Canadian city. We compared dates of injury, MRI, and surgery. A pediatric and musculoskeletal fellowship-trained radiologist reread the MR images, and meniscal injuries were graded according to severity. This was compared with surgical findings described in the operative report. Results Time after injury to MRI and surgery averaged 77 days (range, 1-377 days) and 342 days (range, 42-1637 days), respectively. Patients with new or worsened medial meniscal tears had waited longer for surgery (445 versus 290 days; p = 0.002). Bucket handle medial meniscal tears were more common in patients with surgery more than 1 year after injury than others (15 of 34 versus 14 of 75; p = 0.013). A medial meniscal tear observed on MR images was a significant covariate for a torn meniscus at surgery (relative risk, 5.7; 95% CI, 2.8-11.6). Medial meniscal survival continued to decline sharply greater than 1 year after injury. Conclusions Medial meniscal tears, especially bucket handle tears, increased steadily in frequency more than 1 year after ACL injury. Timely ACL reconstruction may be warranted to reduce the risk of further medial meniscal damage even in patients whose original injury occurred more than 1 year before. Level of Evidence Level IV, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

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“…Principle # 2: There are no surgeries that completely eliminate the potential for growth disturbances A meta-analysis by Frosch et al [31] found significant differences in the overall rate of leg length differences or axis deviation being 5.8 % with physeal sparring techniques and 1.9 % with transphyseal techniques. They used a very judicious value of 1 cm for leg length and greater than 3°for angular deformity.…”

Section: Principlesmentioning

confidence: 99%

Pediatric anterior cruciate ligament reconstruction outcomes

Peterson

Ayeni

2016

Curr Rev Musculoskelet Med

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Treatment of pediatric anterior cruciate injuries have become an area of controversy sparking much debate about best management strategies. Delaying surgery until skeletal maturity has often been shown to result in unfavorable outcomes due to concomitant meniscal and chondral injuries in this population. There have been numerous techniques used to reconstruct the ACL in the skeletally immature patient; however, most studies are limited by small patient numbers and other methodological concerns. With recent publications reporting failure rates as high as 15-25 % and growth disturbances being uncommon but now reported within almost every technical category, patient and caregiver education become of paramount importance. Key principles will be outlined that may help to avoid some of the pitfalls that occur when dealing with this unique population.

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Outcomes and Risks of Operative Treatment of Rupture of the Anterior Cruciate Ligament in Children and Adolescents

Cited by 215 publications

References 83 publications

Pediatric anterior cruciate ligament reconstruction

Pediatric anterior cruciate ligament reconstruction

Meniscal Injury After Adolescent Anterior Cruciate Ligament Injury: How Long Are Patients at Risk?

Pediatric anterior cruciate ligament reconstruction outcomes

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