Pediatric anterior cruciate ligament tears and associated lesions: Epidemiology, diagnostic process, and imaging

Duart, Julio; Rigamonti, L; Bigoni, Marco; Kocher, Minider S

doi:10.1177/18632521231153277

Cited by 13 publications

(9 citation statements)

References 75 publications

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“…Return to the same level of sports activity as before the injury Cordasco [10] 96% 13.5 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) Return to unrestricted competitive sports after successful completion of the QMA and RTS performance analysis Graziano [29] 93% 12 ± 2.0 Athletes were cleared for return to sports based on quantitative measures using the limb symmetry index and qualitative measures (QMA) as well as the ability to meet the demands of their sport. Guzzanti [31] 100% .…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of different autografts used for all-epiphyseal, partial epiphyseal or transphyseal anterior cruciate ligament reconstruction in skeletally immature patients – a systematic review

Verhagen

Dietvorst

Delvaux

et al. 2023

BMC Musculoskelet Disord

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Background Different types of grafts can be used for anterior cruciate ligament reconstruction (ACLR). There is little published data regarding skeletally immature patients. The purpose of this systematic review was to assess the clinical outcomes and complications for different autograft types used in all-epiphyseal, transphyseal and partial epiphyseal/hybrid ACLR in skeletally immature children and adolescents. Methods PubMed, Embase and Cochrane databases were systematically searched for literature regarding ACLR using hamstrings, quadriceps or bone-patellar-tendon-bone (BPTB) autografts in skeletally immature patients. Studies were included if they examined at least one of the following outcomes: graft failure, return to sport(s), growth disturbance, arthrofibrosis or patient reported outcomes and had a minimum follow-up of 1 year. Case reports, conference abstracts and studies examining allografts and extra-articular or over-the-top ACL reconstruction techniques were excluded. Graft failure rates were pooled for each graft type using the quality effects model of MetaXL. A qualitative synthesis of secondary outcomes was performed. Results The database search identified 242 studies. In total 31 studies were included in this review, comprising of 1358 patients. Most patients (81%) were treated using hamstring autograft. The most common used surgical technique was transphyseal. The weighted, pooled failure rate for each graft type was 12% for hamstring tendon autografts, 8% for quadriceps tendon autografts and 6% for BPTB autografts. Confidence intervals were overlapping. The variability in time to graft failure was high. The qualitative analysis of the secondary outcomes showed similar results with good clinical outcomes and low complication rates across all graft types. Conclusions Based on this review it is not possible to determine a superior graft type for ACLR in skeletally immature. Of the included studies, the most common graft type used was the hamstring tendon. Overall, graft failure rates are low, and most studies show good clinical outcomes with high return to sports rates.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of different autografts used for all-epiphyseal, partial epiphyseal or transphyseal anterior cruciate ligament reconstruction in skeletally immature patients – a systematic review

Verhagen

Dietvorst

Delvaux

et al. 2023

BMC Musculoskelet Disord

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“…There has been an increasing incidence of anterior cruciate ligament (ACL) tears in children and adolescents in the past few decades. 8,2 Greater awareness, associated with more accurate diagnosis and higher participation of children in competitive sports, contributes to a trend toward higher number of ACL tears in pediatric and adolescent patients, 2 with databases showing rates of ACL reconstructions on this population rise from nearly threefold to 5.7-fold. 13 Nonoperative management is seen to result in less favorable clinical outcomes regarding participation on sports at the preinjury level of activity, 9 with knee instability contributing to further meniscal and cartilage damage, and arthritic changes.…”

Section: Video Transcriptmentioning

confidence: 99%

Section: Video Transcriptmentioning

confidence: 99%

“…The risk of iatrogenic physeal injuries with operative approach 2 must be considered, since the growth plates around the knee are responsible for 65% to 70% of the longitudinal growth of the lower extremity. 10 Several reconstruction options can be considered depending on the skeletal and physiological age 1 —which is based on Tanner staging system—such as physeal-sparing techniques for skeletally immature patients—and are described to restore joint stability.…”

Section: Video Transcriptmentioning

confidence: 99%

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Anterior Cruciate Ligament Reconstruction With Iliotibial Band Autograft in Skeletally Immature Prepubescent Children: A Physeal-Sparing Technique

Schumacher,

Galvão,

Mameri

et al. 2023

Video Journal of Sports Medicine

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Background: As there has been an increasing incidence of anterior cruciate ligament (ACL) tears in children and adolescents in the past few decades, nonoperative management is seen to result in less favorable clinical outcomes, resulting in meniscal and cartilage damage, and arthritic changes. Despite the risk of iatrogenic physeal injuries with operative approach, several reconstruction options, such as physeal-sparing techniques for skeletally immature patients, are described to restore joint stability. Indications: We bring a combined extra-articular and intra-articular ACL reconstruction technique using autogenous iliotibial band (ITB), which is indicated for prepubescent patients (Tanner stages 1 or 2) with open physes, significant growth potential (≤11 years for girls and ≤12 years for boys) and smaller knees, where an all-epiphyseal ACL reconstruction would lack epiphyseal space Technique Description: The technique consists of a modified MacIntosh intra-articular and extra-articular ITB reconstruction, described by Micheli and further characterized by Kocher. The central portion of the ITB is harvested proximally (at least 15 cm) and left attached to Gerdy's tubercle distally. The harvested graft is brought from over-the-top posteriorly and passed under the intermeniscal ligament anteriorly through an epiphyseal groove on the tibia. Results: The outcomes shown for the Kocher ITB ACL reconstruction technique are favorable at a mean follow-up of 5.3 years: from 44 patients, 41 returned to sports involving cutting or pivoting, and the revision rate was low at 4.5%. Discussion/Conclusion: The awareness of physeal injury related to the operative treatment of ACL tears in the pediatric population has resulted in several physeal-sparing and physeal-respecting techniques of reconstruction. Some of these have shown to reduce the risk of physeal damage, maintaining stability and providing excellent functional outcomes, with low revision rates in long-term follow-up and minimal risk of growth disturbance. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

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“…The most common cause of ACL tears is noncontact injuries. These types of injuries are precipitated by abrupt changes in movement and direction or uncoordinated landings resulting in extreme hyperextension of the knee (Coffey & Bordoni, 2022). Young females are participating in sports at much higher rates than previous generations.…”

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confidence: 99%

Anterior Cruciate Ligament Injury in Young Athletes

Butler,

Moran,

Wilson

2024

Journal of Pediatric Surgical Nursing

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The incidence of anterior cruciate ligament (ACL) tears is increasing in youth, with rates higher in female athletes. The injury is usually noncontact; rather, a quick change of direction induces a “popping” sensation. The injury will be swollen, bruised, and painful, and there will be a limited range of motion and an inability to bear weight. The Lachman test, pivot test (used when patients are anesthetized), and anterior drawer test help diagnose ACL injuries. ACL injuries are categorized by severity as Grade I, II, or III sprains. Prompt first aid care can help reduce pain and swelling using the RICE method, an acronym for rest, ice, compression, and elevation. Medical treatment with stabilization braces might be enough to promote a return-to-normal function, but surgical options are usually required for Grade II and III injuries. Reconstructive surgeries can use an autograft or allograft, but consideration of the growth plates in children might delay the surgery. Postoperative therapy helps reduce edema and immobility. It is essential that injury prevention programs are implemented. Prevention programs and increased awareness of parents and coaches are called for with the population of youth athletes.

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Pediatric anterior cruciate ligament tears and associated lesions: Epidemiology, diagnostic process, and imaging

Cited by 13 publications

References 75 publications

Clinical outcomes of different autografts used for all-epiphyseal, partial epiphyseal or transphyseal anterior cruciate ligament reconstruction in skeletally immature patients – a systematic review

Clinical outcomes of different autografts used for all-epiphyseal, partial epiphyseal or transphyseal anterior cruciate ligament reconstruction in skeletally immature patients – a systematic review

Anterior Cruciate Ligament Reconstruction With Iliotibial Band Autograft in Skeletally Immature Prepubescent Children: A Physeal-Sparing Technique

Anterior Cruciate Ligament Injury in Young Athletes

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