Anterior cruciate ligament injury in children: Update of current treatment options

Current Opinion in Pediatrics

Volumn 15, Issue 1, 2003, Pages 45-52

  Beasley, Leslie S ^a   Chudik, Steven C ^a  

^a HOSPITAL FOR SPECIAL SURGERY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANTERIOR CRUCIATE LIGAMENT RUPTURE; BONE MATURATION; CLINICAL FEATURE; CONSERVATIVE TREATMENT; EPIPHYSIS; GROWTH DISORDER; HUMAN; KNEE ARTHROSCOPY; KNEE INSTABILITY; KNEE MENISCUS RUPTURE; KNEE RADIOGRAPHY; LIGAMENT SURGERY; OSTEOCHONDRITIS; OUTCOMES RESEARCH; PRACTICE GUIDELINE; PRIORITY JOURNAL; PROGNOSIS; REVIEW; SPORT INJURY; SURGICAL ANATOMY; SURGICAL TECHNIQUE;

ADOLESCENT; AGE FACTORS; ANTERIOR CRUCIATE LIGAMENT; CHILD; HUMANS; KNEE; KNEE INJURIES; TIME FACTORS;

EID: 0037305651     PISSN: 10408703     EISSN: None     Source Type: Journal    
DOI: 10.1097/00008480-200302000-00008     Document Type: Review

References (51)

1. Aichroth PM, Patel DV, Zorrilla P: The natural history and treatment of rupture of the anterior cruciate ligament in children and adolescents. A prospective review. J Bone Joint Surg Br 2002, 84:38-41. •• This is a prospective review of 60 children and adolescents with ACL tears; 23 were treated conservatively, which resulted in severe instability and poor knee function. Forty-seven children subsequently underwent ACL reconstruction with a transphyseal technique. None of these children suffered leg-length discrepancies, and overall results were satisfactory in 77%.
2. Andrish JT: Anterior cruciate ligament injuries in the skeletally immature patient. Am J Orthop 2001, 30:103-110.
3. Angel KR, Hall DJ: Anterior cruciate ligament injury in children and adolescents. Arthroscopy 1989, 5:197-200.
4. DeLee JC, Curtis R: Anterior cruciate ligament insufficiency in children. Clin Orthop 1983, 112-118.
5. Engebretsen L, Svenningsen S, Benum P: Poor results of anterior cruciate ligament repair in adolescence. Acta Orthop Scand 1988, 59:684-686.
6. Kannus P, Jarvinen M: Knee ligament injuries in adolescents. Eight-year follow-up of conservative management. J Bone Joint Surg Br 1988, 70:772-776.
7. Lipscomb AB, Anderson AF. Tears of the anterior cruciate ligament in adolescents. J Bone Joint Surg Am 1986, 68:19-28.
8. McCarroll JR, Shelbourne KD, Porter DA, et al.: Patellar tendon graft reconstruction for midsubstance anterior cruciate ligament rupture in junior high school athletes. An algorithm for management. Am J Sports Med 1994, 22:478-484.
9. Skak SV, Jensen TT, Poulsen TD, et al.: Epidemiology of knee injuries in children. Acta Orthop Scand 1987, 58:78-81.
10. Harvell JC Jr, Fu FH, Stanitski CL: Diagnostic arthroscopy of the knee in children and adolescents. Orthopedics 1989, 12:1555-1560.
11. Butler JC, Andrews JR: The role of arthroscopic surgery in the evaluation of acute traumatic hemarthrosis of the knee. Clin Orthop 1988, 150-152.
12. Stanitski CL, Harvell JC, Fu F: Observations on acute knee hemarthrosis in children and adolescents. J Pediatr Orthop 1993, 13:506-510.
13. Binfield PM, Williams LA: Magnetic resonance imaging and arthroscopy of the immature knee. J Bone and Joint Surgery Br 1997, 79B:233.
14. Angel KR, Hall DJ: The role of arthroscopy in children and adolescents. Arthroscopy 1989, 5:192-196.
15. Graf BK, Lange RH, Fujisaki CK, et al.: Anterior cruciate ligament tears in skeletally immature patients: meniscal pathology at presentation and after attempted conservative treatment. Arthroscopy 1992, 8:229-233.
16. Mizuta H, Kubota K, Shiraishi M, et al.: The conservative treatment of complete tears of the anterior cruciate ligament in skeletally immature patients. J Bone Joint Surg Br 1995, 77:890-894.
17. Dodds JA, Arnoczky SP: Anatomy of the anterior cruciate ligament: a blueprint for repair and reconstruction. Arthroscopy 1994, 10:132-139.
18. Behr CT, Potter HG, Paletta GA Jr: The relation of the femoral origin of the anterior cruciate ligament and the distal femoral physeal plate in the skeletally immature knee. An anatomic study. Am J Sports Med 2001, 29:781-787. •• These authors defined the anatomic relation of the femoral origin of the ACL to the distal femoral physis in the skeletally immature knee. They demonstrated that the ACL is an all-epiphyseal structure and that there is no significant change in the distance from the physis to the ACL origin in specimens from birth to adolescence.
19. Shea KG, Apel PJ, Pfeiffer RP, et al.: The tibial attachment of the anterior cruciate ligament in children and adolescents: analysis of magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 2002, 10:102-108. •• This study used MRI to compare the anatomy of the ACL in skeletally immature and adult subjects. They found that anatomic landmarks for the ACL were proportional in both age groups.
20. Janarv PM, Wikstrom B, Hirsch G: The influence of transphyseal drilling and tendon grafting on bone growth: an experimental study in the rabbit. J Pediatr Orthop 1998, 18:149-154.
21. Makela EA, Vainionpaa S, Vihtonen K, et al.: The effect of trauma to the lower femoral epiphyseal plate. An experimental study in rabbits. J Bone Joint Surg Br 1988, 70:187-191.
22. Guzzanti V, Falciglia F, Gigante A, et al.: The effect of intra-articular ACL reconstruction on the growth plates of rabbits. J Bone Joint Surg Br 1994, 76:960-963.
23. Stadelmaier DM, Arnoczky SP, Dodds J, et al.: The effect of drilling and soft tissue grafting across open growth plates. A histologic study. Am J Sports Med 1995, 23:431-435.
24. Campbell CJ, Grisolia A, Zanconato G: The effects produced in the cartilaginous epiphyseal plate of immature dogs by experimental surgical traumata. J Bone Joint Surg Am 1959, 41:1221-1242.
25. Phemister DB: Operative arrestment of the longitudinal growth of bones in the treatment of deformities. J Bone Joint Surg 1933, 15:1-15.
26. Koman JD, Sanders JO: Valgus deformity after reconstruction of the anterior cruciate ligament in a skeletally immature patient. A case report. J Bone Joint Surg Am 1999, 81:711-715.
27. Andrews M, Noyes FR, Barber-Westin SD: Anterior cruciate ligament allograft reconstruction in the skeletally immature athlete. Am J Sports Med 1994, 22:48-54.
28. Janarv PM, Nystrom A, Werner S, et al.: Anterior cruciate ligament injuries in skeletally immature patients. J Pediatr Orthop 1996, 16:673-677.
29. Siffert RS: The effect of staples and longitudinal wires on epiphyseal growth. An experimental study. J Bone Joint Surg Am 1956, 38:1077-1088.
30. Edwards TB, Greene CC, Baratta RV, et al.: The effect of placing a tensioned graft across open growth plates. A gross and histologic analysis. J Bone Joint Surg Am 2001, 83A:725-734. •• This study evaluated the effects of a tensioned connective-tissue graft placed across the skeletally immature canine physis. They reported significant angular deformities in the treated limbs and warned against excessively tensioned transphyseal ACL reconstruction in the skeletally immature population.
31. Kloeppel-Wirth S, Koltai JL, Dittmer H: Significance of arthroscopy in children with knee joint injuries. Eur J Pediatr Surg 1992, 2:169-172.
32. Pressman AE, Letts RM, Jarvis JG: Anterior cruciate ligament tears in children: an analysis of operative versus nonoperative treatment. J Pediatr Orthop 1997, 17:505-511.
33. Aronowitz ER, Ganley TJ, Goode JR, et al.: Anterior cruciate ligament reconstruction in adolescents with open physes. Am J Sports Med 2000, 28:168-175.
34. Edwards PH, Grana WA: Anterior cruciate ligament reconstruction in the immature athlete: long-term results of intra-articular reconstruction. Am J. Knee Surg 2001, 14:232-237. •• This group performed 21 transphyseal ACL reconstructions in children, average age 13.7 years. At follow-up, an average of 34 months later, no limb-length discrepancies or angular deformities were noted. They concluded that ACL reconstruction through bone tunnels successfully eliminated knee instability.
35. Tanner JM, Davies PS: Clinical longitudinal standards for height and height velocity for North American children. J Pediatr 1985, 107:317-329.
36. Stanitski CL: Anterior cruciate ligament injury in the skeletally immature patient: diagnosis and treatment. J Am Acad Orthop Surg 1995, 3:146-158.
37. Fitzgerald SW, Remer EM, Friedman H, et al.: MR evaluation of the anterior cruciate ligament: value of supplementing sagittal images with coronal and axial images. AJR Am J Roentgenol 1993, 160:1233-1237.
38. Twaddle BC, Hunter JC, Chapman JR, et al.: MRI in acute knee dislocation. A prospective study of clinical, MRI, and surgical findings. J Bone Joint Surg Br 1996, 78:573-579.
39. Kocher MS, DiCanzio J, Zurakowski D, et al.: Diagnostic performance of clinical examination and selective magnetic resonance imaging in the evaluation of intraarticular knee disorders in children and adolescents. Am J Sports Med 2001, 29:292-296.
40. Lee K, Siegel MJ, Lau DM, et al.: Anterior cruciate ligament tears: MR imaging-based diagnosis in a pediatric population. Radiology 1999, 213:697-704.
41. Stanitski CL: Conservative treatment of complete ACL tears. J Bone and Joint Surg Br 1996, 78B:681.
42. Callaghan MJ: Conservative treatment of complete ACL tears. J Bone Joint Surg Br 1996, 78:680-681.
43. McCarroll JR, Rettig AC, Shelbourne KD: Anterior cruciate ligament injuries in the young athlete with open physes. Am J Sports Med 1988, 16:44-47.
44. Kim SH, Ha KI, Ahn JH, et al.: Anterior cruciate ligament reconstruction in the young patient without violation of the epiphyseal plate. Arthroscopy 1999, 15:792-795.
45. Micheli LJ, Rask B, Gerberg L: Anterior cruciate ligament reconstruction in patients who are prepubescent. Clin Orthop 1999, 40-47.
46. Parker AW, Drez D Jr, Cooper JL: Anterior cruciate ligament injuries in patients with open physes. Am J Sports Med 1994, 22:44-47.
47. Brief LP: Anterior cruciate ligament reconstruction without drill holes. Arthroscopy 1991, 7:350-357.
48. Lo IK, Kirkley A, Fowler PJ, et al.: The outcome of operatively treated anterior cruciate ligament disruptions in the skeletally immature child. Arthroscopy 1997, 13:627-634.
49. Kocher MS, Saxon HS, Hovis WD, et al.: Management and complications of anterior cruciate ligament injuries in skeletally immature patients: survey of the Herodicus Society and The ACL Study Group. J Pediatr Orthop 2002, 22:452-457. •• Management and complications of pediatric ACL injuries was studied by surveying the members of the Herodicus Society and the ACL Study Group. They noted a wide practice variation in terms of management and that significant growth disturbances are rare. They recommend a guarded approach to ACL reconstruction in the skeletally immature patient with careful attention to technique.
50. Anderson AF: Anatomic, physeal sparing anterior cruciate ligament reconstruction in skeletally immature patients using quadruple hamstring grafts. In: ACL Study Group Meeting. Boseman, MT: 2002. •• Anderson presented 4.2 years follow-up of 12 patients, average age 13, who underwent anatomic, physeal-sparing ACL reconstruction. He reported good subjective and objective outcomes with no significant limb-length inequality. He concluded that this was a safe and effective technique for preadolescent patients.
51. Paletta GA: ACL reconstruction in the skeletally immature athlete: comparison of two techniques. In: ACL Study Group Meeting. Boseman, MT: 2002. •• Paletta presented a comparison of ACL reconstruction techniques in 14 skeletally immature patients, aged 10-13 years. In all patients, the tibial tunnel was transphyseal, whereas in 6 of 14, the femoral limb was placed over-the-top, and in the remaining 8, it was transphyseal. At 2 years follow-up, no patients demonstrated significant leg-length discrepancies or angular deformities. Objective measurements of stability were superior in the transphyseal femoral tunnel group; however, subjectively and in regards to level of return to play, both yielded good results and were demonstrated to be safe in this skeletally immature age group.