Download PDF
Z Orthop Unfall 2022; 160(04): 393-399
DOI: 10.1055/a-1352-5541
Original Article/Originalarbeit

17-Year Results following Transepiphyseal Anterior Cruciate Ligament Reconstruction in Children and Adolescents

Article in several languages: English | deutsch
Alexander Zimmerer   *
1   Orthopaedic Clinic, ARCUS Clinic for Sports Medicine, Pforzheim, Germany
2   Orthopaedic and Orthopaedic Surgery Clinic, University Medical Clinics Greifswald, Germany
,
Marco M. Schneider   *
1   Orthopaedic Clinic, ARCUS Clinic for Sports Medicine, Pforzheim, Germany
,
Carina Semann
1   Orthopaedic Clinic, ARCUS Clinic for Sports Medicine, Pforzheim, Germany
,
Wolfgang Schopf
1   Orthopaedic Clinic, ARCUS Clinic for Sports Medicine, Pforzheim, Germany
,
Christian Sobau   *
1   Orthopaedic Clinic, ARCUS Clinic for Sports Medicine, Pforzheim, Germany
,
Andree Ellermann   *
1   Orthopaedic Clinic, ARCUS Clinic for Sports Medicine, Pforzheim, Germany
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective Rupture of the anterior cruciate ligament (ACL) in childhood and adolescence is a serious injury. It is now known that conservative therapy of an unstable knee joint in childhood or adolescence under can lead to poor subjective and objective results. The aim of this study is to record long-term results after transepiphyseal ACL reconstruction using autologous hamstring tendons and extracortical fixation in childhood and adolescence with open physes – at least 15 years after surgery.

Methods Our internal registry was used to identify all patients who received surgical treatment of an acl tear during childhood and adolescence by transepiphyseal acl reconstruction more than 15 years previously. In these patients, the International Knee Documentation Committee for Subjective Knee Form (IKDCsubj.), Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Score (TAS) and Lysholm Score were collected, and clinical and magnetic resonance imaging (MRI) examinations were performed.

Results A total of 22 patients were identified, 5 of whom could not be contacted. The mean age at the time of surgery was 13.1 years, and the mean follow-up time was 17.4 years. In 3 patients, a traumatic tear was observed with subsequent reconstruction of the ACL. None of the included patients showed a growth disorder during the course of the study. The IKDCsubj. was 92.4 ± 14.7 (48 – 100), the Lysholm score was 87.9 ± 16.9 (34 – 100), the TAS was 5.7 ± 2.3 (3 – 9) and the pain level based on VAS was 3.5 ± 2.6 (1 – 8) points. The values showed subjective and objective deterioration compared to the 10-year results, with no statistical significance. The following subscores were reported for the KOOS: KOOSpain 90.9 ± 17.6 (28 – 100); KOOSsymptom 82.9 ± 22.6 (11 – 100); KOOOSADL 94.3 ± 13.7 (44 – 100); KOOSSport 80.3 ± 26.4 (15 – 100); KOOSQOL 80.9 ± 25.8 (0 – 100). 13 of the 17 patients could also be clinically and radiologically examined. In 92% of patients, an intact acl reconstruction was found without evidence of cartilage or meniscus damage. The mean lateral difference in the KT-1000 measurement was 1.5 mm.

Conclusion ACL reconstruction in childhood and adolescence provides good functionality and stability of the knee joint over the long term. Secondary signs of osteoarthritis can only be detected in isolated cases by MRI. ACL reconstruction using the transepiphyseal technique can be considered the method of choice for open growth plate knee joints.

Key words

anterior cruciate ligament - long-term results - reconstruction - children - adolescents

* Dr Schneider (currently second-listed author) shared authorship with me and Dr Sobau and Dr Ellermann (authors listed 5th and 6th) shared senior authorship.




Publication History

Article published online:
18 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References/Literatur

  • 1 Fabricant PD, Kocher MS. Anterior Cruciate Ligament Injuries in Children and Adolescents. Orthop Clin North Am 2016; 47: 777-788
    CrossrefPubMedGoogle Scholar
  • 2 Sanders TL, Maradit Kremers H, Bryan AJ. et al. Incidence of Anterior Cruciate Ligament Tears and Reconstruction. A 21-Year Population-Based Study. Am J Sports Med 2016; 44: 1502-1507
    CrossrefPubMedGoogle Scholar
  • 3 Dodwell ER, Lamont LE, Green DW. et al. 20 years of pediatric anterior cruciate ligament reconstruction in New York State. Am J Sports Med 2014; 42: 675-680
    CrossrefPubMedGoogle Scholar
  • 4 Werner BC, Yang S, Looney AM. et al. Trends in Pediatric and Adolescent Anterior Cruciate Ligament Injury and Reconstruction. J Pediatr Orthop 2016; 36: 447-452
    CrossrefPubMedGoogle Scholar
  • 5 Shea KG, Pfeiffer R, Wang JH. et al. Anterior cruciate ligament injury in pediatric and adolescent soccer players. An analysis of insurance data. J Pediatr Orthop 2004; 24: 623-628
    CrossrefPubMedGoogle Scholar
  • 6 Kraus T, Švehlík M, Singer G. et al. The epidemiology of knee injuries in children and adolescents. Arch Orthop Trauma Surg 2012; 132: 773-779
    CrossrefPubMedGoogle Scholar
  • 7 Shultz SJ, Schmitz RJ, Cameron KL. et al. Anterior Cruciate Ligament Research Retreat VIII Summary Statement. An Update on Injury Risk Identification and Prevention Across the Anterior Cruciate Ligament Injury Continuum, March 14–16, 2019, Greensboro, NC. J Athl Train 2019; 54: 970-984
    CrossrefPubMedGoogle Scholar
  • 8 Vacek PM, Slauterbeck JR, Tourville TW. et al. Multivariate Analysis of the Risk Factors for First-Time Noncontact ACL Injury in High School and College Athletes. A Prospective Cohort Study With a Nested, Matched Case-Control Analysis. Am J Sports Med 2016; 44: 1492-1501
    CrossrefPubMedGoogle Scholar
  • 9 Stracciolini A, Stein CJ, Zurakowski D. et al. Anterior cruciate ligament injuries in pediatric athletes presenting to sports medicine clinic. A comparison of males and females through growth and development. Sports Health 2015; 7: 130-136
    CrossrefPubMedGoogle Scholar
  • 10 Diekfuss JA, Grooms DR, Yuan W. et al. Does brain functional connectivity contribute to musculoskeletal injury? A preliminary prospective analysis of a neural biomarker of ACL injury risk. J Sci Med Sport 2019; 22: 169-174
    CrossrefPubMedGoogle Scholar
  • 11 Swanik CB. Brains and Sprains. The Brainʼs Role in Noncontact Anterior Cruciate Ligament Injuries. J Athl Train 2015; 50: 1100-1102
    CrossrefPubMedGoogle Scholar
  • 12 Uhorchak JM, Scoville CR, Williams GN. et al. Risk factors associated with noncontact injury of the anterior cruciate ligament. A prospective four-year evaluation of 859 West Point cadets. Am J Sports Med 2003; 31: 831-842
    CrossrefPubMedGoogle Scholar
  • 13 Drenck TC, Akoto R, Meenen NM. et al. Ligamentäre Kniegelenkverletzungen im Wachstumsalter. Unfallchirurg 2016; 119: 581-597
    CrossrefPubMedGoogle Scholar
  • 14 MacAlpine EM, Talwar D, Storey EP. et al. Weight Gain After ACL Reconstruction in Pediatric and Adolescent Patients. Sports Health 2020; 12: 29-35
    CrossrefPubMedGoogle Scholar
  • 15 Krause M, Freudenthaler F, Frosch K-H. et al. Operative Versus Conservative Treatment of Anterior Cruciate Ligament Rupture. Dtsch Arztebl Int 2018; 115: 855-862
    CrossrefPubMedGoogle Scholar
  • 16 Milewski MD, Beck NA, Lawrence JT. et al. Anterior cruciate ligament reconstruction in the young athlete. A treatment algorithm for the skeletally immature. Clin Sports Med 2011; 30: 801-810
    CrossrefPubMedGoogle Scholar
  • 17 Hudgens JL, Dahm DL. Treatment of anterior cruciate ligament injury in skeletally immature patients. Int J Pediatr 2012; 2012: 932702
    CrossrefPubMedGoogle Scholar
  • 18 Ramski DE, Kanj WW, Franklin CC. et al. Anterior cruciate ligament tears in children and adolescents. A meta-analysis of nonoperative versus operative treatment. Am J Sports Med 2014; 42: 2769-2776
    CrossrefPubMedGoogle Scholar
  • 19 Mohtadi N, Grant J. Managing anterior cruciate ligament deficiency in the skeletally immature individual. A systematic review of the literature. Clin J Sport Med 2006; 16: 457-464
    CrossrefPubMedGoogle Scholar
  • 20 Preiss A, Brodhun T, Stietencron I. et al. Die vordere Kreuzbandruptur im Wachstumsalter – operativ oder konservativ? Ein systematisches Review. Unfallchirurg 2012; 115: 848-854
    CrossrefPubMedGoogle Scholar
  • 21 Moksnes H, Engebretsen L, Risberg MA. The current evidence for treatment of ACL injuries in children is low. A systematic review. J Bone Joint Surg Am 2012; 94: 1112-1119
    CrossrefPubMedGoogle Scholar
  • 22 Woods GW, OʼConnor DP. Delayed anterior cruciate ligament reconstruction in adolescents with open physes. Am J Sports Med 2004; 32: 201-210
    CrossrefPubMedGoogle Scholar
  • 23 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
    CrossrefPubMedGoogle Scholar
  • 24 Henry J, Chotel F, Chouteau J. et al. Rupture of the anterior cruciate ligament in children. Early reconstruction with open physes or delayed reconstruction to skeletal maturity?. Knee Surg Sports Traumatol Arthrosc 2009; 17: 748-755
    CrossrefPubMedGoogle Scholar
  • 25 Janarv PM, Nyström A, Werner S. et al. Anterior cruciate ligament injuries in skeletally immature patients. J Pediatr Orthop 1996; 16: 673-677
    CrossrefPubMedGoogle Scholar
  • 26 Moksnes H, Engebretsen L, Risberg MA. Management of anterior cruciate ligament injuries in skeletally immature individuals. J Orthop Sports Phys Ther 2012; 42: 172-183
    CrossrefPubMedGoogle Scholar
  • 27 Hamrin Senorski E, Seil R, Svantesson E. et al. “I never made it to the pros…” Return to sport and becoming an elite athlete after pediatric and adolescent anterior cruciate ligament injury-Current evidence and future directions. Knee Surg Sports Traumatol Arthrosc 2018; 26: 1011-1018
    PubMedGoogle Scholar
  • 28 Lawrence JTR, Argawal N, Ganley TJ. Degeneration of the knee joint in skeletally immature patients with a diagnosis of an anterior cruciate ligament tear. Is there harm in delay of treatment?. Am J Sports Med 2011; 39: 2582-2587
    CrossrefPubMedGoogle Scholar
  • 29 Mehl J, Otto A, Baldino JB. et al. The ACL-deficient knee and the prevalence of meniscus and cartilage lesions. A systematic review and meta-analysis (CRD42017076897). Arch Orthop Trauma Surg 2019; 139: 819-841
    CrossrefPubMedGoogle Scholar
  • 30 Dumont GD, Hogue GD, Padalecki JR. et al. Meniscal and chondral injuries associated with pediatric anterior cruciate ligament tears. Relationship of treatment time and patient-specific factors. Am J Sports Med 2012; 40: 2128-2133
    CrossrefPubMedGoogle Scholar
  • 31 Kay J, Memon M, Marx RG. et al. Over 90 % of children and adolescents return to sport after anterior cruciate ligament reconstruction. A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2018; 26: 1019-1036
    CrossrefPubMedGoogle Scholar
  • 32 Kay J, Memon M, Shah A. et al. Earlier anterior cruciate ligament reconstruction is associated with a decreased risk of medial meniscal and articular cartilage damage in children and adolescents. A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2018; 26: 3738-3753
    CrossrefPubMedGoogle Scholar
  • 33 Frosch K-H, Stengel D, Brodhun T. et al. Outcomes and risks of operative treatment of rupture of the anterior cruciate ligament in children and adolescents. Arthroscopy 2010; 26: 1539-1550
    CrossrefPubMedGoogle Scholar
  • 34 Lanzetti RM, Pace V, Ciompi A. et al. Over the top anterior cruciate ligament reconstruction in patients with open physes. A long-term follow-up study. Int Orthop 2020; 44: 771-778
    CrossrefPubMedGoogle Scholar
  • 35 Calvo R, Figueroa D, Gili F. et al. Transphyseal anterior cruciate ligament reconstruction in patients with open physes. 10-year follow-up study. Am J Sports Med 2015; 43: 289-294
    CrossrefPubMedGoogle Scholar
  • 36 Marx A, Siebold R, Sobau C. et al. Ersatz des vorderen Kreuzbandes bei Kindern und Jugendlichen mit offenen Wachstumsfugen. Z Orthop Unfall 2008; 146: 715-719
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Redler LH, Brafman RT, Trentacosta N. et al. Anterior cruciate ligament reconstruction in skeletally immature patients with transphyseal tunnels. Arthroscopy 2012; 28: 1710-1717
    CrossrefPubMedGoogle Scholar
  • 38 Wall EJ, Ghattas PJ, Eismann EA. et al. Outcomes and Complications After All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients. Orthop J Sports Med 2017; 5: 2325967117693604 DOI: 10.1177/2325967117693604.
    CrossrefPubMedGoogle Scholar
  • 39 Buckle C, Wainwright AM. A systematic review of long-term patient reported outcomes for the treatment of anterior cruciate ligament injuries in the skeletally immature. J Child Orthop 2018; 12: 251-261
    CrossrefPubMedGoogle Scholar
  • 40 Irrgang JJ, Anderson AF, Boland AL. et al. Development and Validation of the International Knee Documentation Committee Subjective Knee Form. Am J Sports Med 2017; 29: 600-613
    CrossrefPubMedGoogle Scholar
  • 41 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; (198) 43-49
    PubMedGoogle Scholar
  • 42 Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 2016; 10: 150-154
    CrossrefPubMedGoogle Scholar
  • 43 Roos EM, Roos HP, Lohmander LS. et al. Knee Injury and Osteoarthritis Outcome Score (KOOS)–Development of a Self-Administered Outcome Measure. J Orthop Sports Phys Ther 1998; 28: 88-96
    CrossrefPubMedGoogle Scholar
  • 44 Schopf W. Langzeit Follow-up nach Vorderer-Kreuzband-Plastik im Kindes-/Jugendalter zur Identifikation degenerativer Gelenkerkrankungen, Funktions- und Wachstumsstörungen [Dissertation]. Heidelberg: Universität Heidelberg; 2017
    PubMedGoogle Scholar
  • 45 Seil R, Robert H. VKB-Plastik bei offenen Wachstumsfugen. Arthroskopie 2005; 18: 48-52
    CrossrefPubMedGoogle Scholar
  • 46 Karikis I, Åhlén M, Sernert N. et al. The Long-Term Outcome After Early and Late Anterior Cruciate Ligament Reconstruction. Arthroscopy 2018; 34: 1907-1917
    CrossrefPubMedGoogle Scholar
  • 47 Hagmeijer MH, Hevesi M, Desai VS. et al. Secondary Meniscal Tears in Patients With Anterior Cruciate Ligament Injury. Relationship Among Operative Management, Osteoarthritis, and Arthroplasty at 18-Year Mean Follow-up. Am J Sports Med 2019; 47: 1583-1590
    CrossrefPubMedGoogle Scholar
  • 48 Rothrauff BB, Jorge A, de Sa D. et al. Anatomic ACL reconstruction reduces risk of post-traumatic osteoarthritis: a systematic review with minimum 10-year follow-up. Knee Surg Sports Traumatol Arthrosc 2020; 28: 1072-1084
    CrossrefPubMedGoogle Scholar
  • 49 Claes S, Hermie L, Verdonk R. et al. Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis. Knee Surg Sports Traumatol Arthrosc 2013; 21: 1967-1976
    CrossrefPubMedGoogle Scholar
  • 50 Magnussen RA, Meschbach NT, Kaeding CC. et al. ACL Graft and Contralateral ACL Tear Risk within Ten Years Following Reconstruction. A Systematic Review. JBJS Rev 2015; 3: e3 DOI: 10.2106/JBJS.RVW.N.00052.
    CrossrefPubMedGoogle Scholar
  • 51 Pierce TP, Issa K, Festa A. et al. Pediatric Anterior Cruciate Ligament Reconstruction. A Systematic Review of Transphyseal Versus Physeal-Sparing Techniques. Am J Sports Med 2017; 45: 488-494
    CrossrefPubMedGoogle Scholar
  • 52 Collins MJ, Arns TA, Leroux T. et al. Growth Abnormalities Following Anterior Cruciate Ligament Reconstruction in the Skeletally Immature Patient. A Systematic Review. Arthroscopy 2016; 32: 1714-1723
    CrossrefPubMedGoogle Scholar
  • 53 Longo UG, Ciuffreda M, Casciaro C. et al. Anterior cruciate ligament reconstruction in skeletally immature patients. A systematic review. Bone Joint J 2017; 99-B: 1053-1060
    CrossrefPubMedGoogle Scholar
  • 54 Larson CM, Heikes CS, Ellingson CI. et al. Allograft and Autograft Transphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients. Outcomes and Complications. Arthroscopy 2016; 32: 860-867
    CrossrefPubMedGoogle Scholar
  • 55 Dekker TJ, Godin JA, Dale KM. et al. Return to Sport After Pediatric Anterior Cruciate Ligament Reconstruction and Its Effect on Subsequent Anterior Cruciate Ligament Injury. J Bone Joint Surg Am 2017; 99: 897-904
    CrossrefPubMedGoogle Scholar
  • 56 Cox CL. The Quandary of Treating Anterior Cruciate Ligament Tears in Children and Adolescents. Commentary on an article by Travis J. Dekker, MD, et al.: “Return to Sport After Pediatric Anterior Cruciate Ligament Reconstruction and Its Effect on Subsequent Anterior Cruciate Ligament Injury”. J Bone Joint Surg Am 2017; 99: e58
    CrossrefPubMedGoogle Scholar
  • 57 Zebis MK, Warming S, Pedersen MB. et al. Outcome Measures After ACL Injury in Pediatric Patients. A Scoping Review. Orthop J Sports Med 2019; 7: 2325967119861803
    Google Scholar
  • 58 Brusalis CM, Lakomkin N, Suryavanshi JR. et al. Clinical Outcome Reporting in Youth ACL Literature Is Widely Variable. Orthop J Sports Med 2017; 5: 2325967117724431
    CrossrefPubMedGoogle Scholar