Patellar Tendon Graft Reconstruction for Midsubstance Anterior Cruciate Ligament Rupture in Junior High School Athletes

Abstract

Between 1976 and 1988 we treated 75 junior high athletes who had midsubstance ruptures of the anterior cruciate ligament and open physes. Thirty-eight children were initially treated conservatively and later had an intraarticular patellar tendon graft reconstruction, 2 patients underwent extraarticular reconstruction and then later had a patellar tendon graft intraarticular reconstruction, and 20 children had a patellar tendon graft reconstruction initially. In all 60 patients the tibial and femoral tunnels were drilled through the open physes. Minimum followup was 2 years (mean, 4.2). Fifty-five of the 60 children were able to return to their original sports; 5 were active in less strenuous sports. No incidence of abnormal growth related to the intraarticular reconstructive surgery was recorded. Three children tore their anterior cruciate ligament grafts more than 2 years after surgery. Our records showed that conservative treatment of the active junior high athlete with an anterior cruciate ligament rupture failed in each case because of recurrent giving way or meniscal tears. Definitive treatment with an intraarticular autogenous patellar tendon graft reconstruction yielded good to excellent results and eliminated subsequent instability episodes and meniscal tears in our study group.

Surgical Technique: Does Mini-invasive Medial Collateral Ligament and Posterior Oblique Ligament Repair Restore Knee Stability in Combined Chronic Medial and ACL Injuries?

“…Controversies still exist in the management of combined ACL and MCL injuries: according to some authors, ACL reconstruction is sufficient to restore knee stability [5,16,28], whereas others advocate repair of both the ACL and MCL [2,6,21]. The current trend consists in less aggressive treatment of medial laxity with great effort to improve ACL reconstruction [17], but in Grade III medial injuries, both the MCL and POL are damaged with a substantial increase of external rotation.…”

Pediatric anterior cruciate ligament reconstruction

“…At 72 months post-injury those managed nonoperatively required significant reduction in activity, had significant decline in their Lysholm score and many had signs of early osteoarthritis. McCarroll et al [26] found in 38 patients with ACL injuries followed for 4.2 years that 27 developed signs of meniscal injury and 37 of 38 had instability symptoms. Mizuta et al [27] presented similar results in 18 patients managed non-operatively.…”

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

“…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.…”