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Eur J Pediatr Surg 2013; 23(06): 464-469
DOI: 10.1055/s-0033-1363162
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Anterior Cruciate Ligament Injuries in Children and Adolescents: A Review of the Recent Literature

Kai Ziebarth
1   Section of Pediatric Orthopedics, Department of Pediatric Surgery, University Childrenʼs Hospital, Bern, Switzerland
,
D. Kolp
1   Section of Pediatric Orthopedics, Department of Pediatric Surgery, University Childrenʼs Hospital, Bern, Switzerland
,
Sandro Kohl
2   Department of Orthopedic Surgery, University Childrenʼs Hospital, Bern, Switzerland
,
Theddy Slongo
1   Section of Pediatric Orthopedics, Department of Pediatric Surgery, University Childrenʼs Hospital, Bern, Switzerland
› Author Affiliations
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Publication History

05 November 2013

10 November 2013

Publication Date:
10 December 2013 (online)

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Abstract

In contrast to the treatment of avulsion lesions of the anterior cruciate ligament (ACL) the management of intrasubstance ACL tears in the skeletally immature patient remains controversial. Prospective studies could show that conservative treatment results in severe instability with concomitant intraarticular damage and poor function of the knee. Reconstruction of a torn ACL always carries the risk of damaging the open growth plates; with consecutively affecting the longitudinal or axial growth of the lower extremity either on the femoral or the tibial side. Thus, several surgical procedures are available to prevent adverse events mentioned above. The purpose of this study is to review the recent literature regarding the treatment algorithm for ACL injuries in skeletally immature patients. This review will (1) investigate the indications for ACL surgery in children; (2) determine if a surgical procedure is clinically superior in skeletally immature patients; and (3) correlate the adverse events with the surgical technique.

Keywords

anterior cruciate ligament - surgery - children
 

  • References

  • 1 Simon TD, Bublitz C, Hambidge SJ. External causes of pediatric injury-related emergency department visits in the United States. Acad Emerg Med 2004; 11 (10) 1042-1048
    CrossrefPubMedGoogle Scholar
  • 2 Lo IK, Bell DM, Fowler PJ. Anterior cruciate ligament injuries in the skeletally immature patient. Instr Course Lect 1998; 47: 351-359
    PubMedGoogle Scholar
  • 3 Dorizas JA, Stanitski CL. Anterior cruciate ligament injury in the skeletally immature. Orthop Clin North Am 2003; 34 (3) 355-363
    CrossrefPubMedGoogle Scholar
  • 4 Bales CP, Guettler JH, Moorman III CT. Anterior cruciate ligament injuries in children with open physes: evolving strategies of treatment. Am J Sports Med 2004; 32 (8) 1978-1985
    CrossrefPubMedGoogle Scholar
  • 5 Caine D, Maffulli N, Caine C. Epidemiology of injury in child and adolescent sports: injury rates, risk factors, and prevention. Clin Sports Med 2008; 27 (1) 19-50 , vii
    CrossrefPubMedGoogle Scholar
  • 6 Øiestad BE, Engebretsen L, Storheim K, Risberg MA. Knee osteoarthritis after anterior cruciate ligament injury: a systematic review. Am J Sports Med 2009; 37 (7) 1434-1443
    CrossrefPubMedGoogle Scholar
  • 7 Millett PJ, Willis AA, Warren RF. Associated injuries in pediatric and adolescent anterior cruciate ligament tears: does a delay in treatment increase the risk of meniscal tear?. Arthroscopy 2002; 18 (9) 955-959
    CrossrefPubMedGoogle Scholar
  • 8 Preiss A, Brodhun T, Stietencron I, Frosch KH. [Rupture of the anterior cruciate ligament in growing children: surgical or conservative treatment? A systematic review]. Unfallchirurg 2012; 115 (9) 848-854
    CrossrefPubMedGoogle Scholar
  • 9 Samora III WP, Palmer R, Klingele KE. Meniscal pathology associated with acute anterior cruciate ligament tears in patients with open physes. J Pediatr Orthop 2011; 31 (3) 272-276
    CrossrefPubMedGoogle Scholar
  • 10 Stanitski CL, Harvell JC, Fu FH. Observations on acute knee hemarthrosis in children and adolescents. J Pediatr Orthop 1993; 13 (4) 506-510
    CrossrefPubMedGoogle Scholar
  • 11 Luhmann SJ. Acute traumatic knee effusions in children and adolescents. J Pediatr Orthop 2003; 23 (2) 199-202
    CrossrefPubMedGoogle Scholar
  • 12 Shea KG, Pfeiffer R, Wang JH, Curtin M, Apel PJ. Anterior cruciate ligament injury in pediatric and adolescent soccer players: an analysis of insurance data. J Pediatr Orthop 2004; 24 (6) 623-628
    CrossrefPubMedGoogle Scholar
  • 13 Meyers MH, McKEEVER FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am 1959; 41-A (2) 209-220 , discussion 220–222
    PubMedGoogle Scholar
  • 14 Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am 1970; 52 (8) 1677-1684
    CrossrefPubMedGoogle Scholar
  • 15 Vavken P, Murray MM. Treating anterior cruciate ligament tears in skeletally immature patients. Arthroscopy 2011; 27 (5) 704-716
    CrossrefPubMedGoogle Scholar
  • 16 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 (6) 457-464
    CrossrefPubMedGoogle Scholar
  • 17 Woods GW, O'Connor DP. Delayed anterior cruciate ligament reconstruction in adolescents with open physes. Am J Sports Med 2004; 32 (1) 201-210
    CrossrefPubMedGoogle Scholar
  • 18 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 (1) 38-41
    CrossrefPubMedGoogle Scholar
  • 19 Mizuta H, Kubota K, Shiraishi M, Otsuka Y, Nagamoto N, Takagi K. The conservative treatment of complete tears of the anterior cruciate ligament in skeletally immature patients. J Bone Joint Surg Br 1995; 77 (6) 890-894
    PubMedGoogle Scholar
  • 20 Graf BK, Lange RH, Fujisaki CK, Landry GL, Saluja RK. Anterior cruciate ligament tears in skeletally immature patients: meniscal pathology at presentation and after attempted conservative treatment. Arthroscopy 1992; 8 (2) 229-233
    CrossrefPubMedGoogle Scholar
  • 21 Cohen M, Ferretti M, Quarteiro M , et al. Transphyseal anterior cruciate ligament reconstruction in patients with open physes. Arthroscopy 2009; 25 (8) 831-838
    PubMedGoogle Scholar
  • 22 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 (5) 711-715
    PubMedGoogle Scholar
  • 23 Kocher MS, Saxon HS, Hovis WD, Hawkins RJ. 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 (4) 452-457
    CrossrefPubMedGoogle Scholar
  • 24 Chotel F, Henry J, Seil R, Chouteau J, Moyen B, Bérard J. Growth disturbances without growth arrest after ACL reconstruction in children. Knee Surg Sports Traumatol Arthrosc 2010; 18 (11) 1496-1500
    CrossrefPubMedGoogle Scholar
  • 25 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 (4) 232-237
    PubMedGoogle Scholar
  • 26 Kocher MS, Garg S, Micheli LJ. Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescents. Surgical technique. J Bone Joint Surg Am 2006; 88 (Suppl 1 Pt 2): 283-293
    PubMedGoogle Scholar
  • 27 Kocher MS, Smith JT, Zoric BJ, Lee B, Micheli LJ. Transphyseal anterior cruciate ligament reconstruction in skeletally immature pubescent adolescents. J Bone Joint Surg Am 2007; 89 (12) 2632-2639
    CrossrefPubMedGoogle Scholar
  • 28 Micheli LJ, Rask B, Gerberg L. Anterior cruciate ligament reconstruction in patients who are prepubescent. Clin Orthop Relat Res 1999; (364) 40-47
    PubMedGoogle Scholar
  • 29 Guzzanti V, Falciglia F, Stanitski CL. Physeal-sparing intraarticular anterior cruciate ligament reconstruction in preadolescents. Am J Sports Med 2003; 31 (6) 949-953
    PubMedGoogle Scholar
  • 30 Janarv PM, Nyström A, Werner S, Hirsch G. Anterior cruciate ligament injuries in skeletally immature patients. J Pediatr Orthop 1996; 16 (5) 673-677
    CrossrefPubMedGoogle Scholar
  • 31 Kocher MS, Garg S, Micheli LJ. Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescents. J Bone Joint Surg Am 2005; 87 (11) 2371-2379
    CrossrefPubMedGoogle Scholar
  • 32 Gebhard F, Ellermann A, Hoffmann F, Jaeger JH, Friederich NF. Multicenter-study of operative treatment of intraligamentous tears of the anterior cruciate ligament in children and adolescents: comparison of four different techniques. Knee Surg Sports Traumatol Arthrosc 2006; 14 (9) 797-803
    CrossrefPubMedGoogle Scholar
  • 33 Graf BK, Lange RH, Fujisaki CK, Landry GL, Saluja RK. Anterior cruciate ligament tears in skeletally immature patients: meniscal pathology at presentation and after attempted conservative treatment. Arthroscopy 1992; 8 (2) 229-233
    CrossrefPubMedGoogle Scholar
  • 34 Anderson AF. Transepiphyseal replacement of the anterior cruciate ligament in skeletally immature patients. A preliminary report. J Bone Joint Surg Am 2003; 85-A (7) 1255-1263
    PubMedGoogle Scholar
  • 35 Lawrence JT, Bowers AL, Belding J, Cody SR, Ganley TJ. All-epiphyseal anterior cruciate ligament reconstruction in skeletally immature patients. Clin Orthop Relat Res 2010; 468 (7) 1971-1977
    CrossrefPubMedGoogle Scholar
  • 36 Kohl S, Stutz C, Decker S , et al. Mid-term results of transphyseal anterior cruciate ligament reconstruction in children and adolescents. Knee 2013;
    PubMedGoogle Scholar
  • 37 Lo IK, Kirkley A, Fowler PJ, Miniaci A. The outcome of operatively treated anterior cruciate ligament disruptions in the skeletally immature child. Arthroscopy 1997; 13 (5) 627-634
    CrossrefPubMedGoogle Scholar
  • 38 McIntosh AL, Dahm DL, Stuart MJ. Anterior cruciate ligament reconstruction in the skeletally immature patient. Arthroscopy 2006; 22 (12) 1325-1330
    PubMedGoogle Scholar
  • 39 Hui C, Roe J, Ferguson D, Waller A, Salmon L, Pinczewski L. Outcome of anatomic transphyseal anterior cruciate ligament reconstruction in Tanner stage 1 and 2 patients with open physes. Am J Sports Med 2012; 40 (5) 1093-1098
    CrossrefPubMedGoogle Scholar
  • 40 Courvoisier A, Grimaldi M, Plaweski S. Good surgical outcome of transphyseal ACL reconstruction in skeletally immature patients using four-strand hamstring graft. Knee Surg Sports Traumatol Arthrosc 2011; 19 (4) 588-591
    CrossrefPubMedGoogle Scholar
  • 41 Shea KG, Pfeiffer R, Wang JH, Curtin M, Apel PJ. Anterior cruciate ligament injury in pediatric and adolescent soccer players: an analysis of insurance data. J Pediatr Orthop 2004; 24 (6) 623-628
    CrossrefPubMedGoogle Scholar
  • 42 Hagel B. Skiing and snowboarding injuries. Med Sport Sci 2005; 48: 74-119
    PubMedGoogle Scholar
  • 43 Meyers MC, Laurent Jr CM, Higgins RW, Skelly WA. Downhill ski injuries in children and adolescents. Sports Med 2007; 37 (6) 485-499
    CrossrefPubMedGoogle Scholar
  • 44 Frosch KH, 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 (11) 1539-1550
    PubMedGoogle Scholar
  • 45 Beasley LS, Chudik SC. Anterior cruciate ligament injury in children: update of current treatment options. Curr Opin Pediatr 2003; 15 (1) 45-52
    CrossrefPubMedGoogle Scholar
  • 46 Dumont GD, Hogue GD, Padalecki JR, Okoro N, Wilson PL. 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 (9) 2128-2133
    CrossrefPubMedGoogle Scholar
  • 47 Henry J, Chotel F, Chouteau J, Fessy MH, Bérard J, Moyen B. 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 (7) 748-755
    CrossrefPubMedGoogle Scholar
  • 48 Moksnes H, Engebretsen L, Risberg MA. Prevalence and incidence of new meniscus and cartilage injuries after a nonoperative treatment algorithm for ACL tears in skeletally immature children: a prospective MRI study. Am J Sports Med 2013; 41 (8) 1771-1779
    CrossrefPubMedGoogle Scholar
  • 49 Larsen MW, Garrett Jr WE, Delee JC, Moorman III CT. Surgical management of anterior cruciate ligament injuries in patients with open physes. J Am Acad Orthop Surg 2006; 14 (13) 736-744
    PubMedGoogle Scholar
  • 50 Chudik S, Beasley L, Potter H, Wickiewicz T, Warren R, Rodeo S. The influence of femoral technique for graft placement on anterior cruciate ligament reconstruction using a skeletally immature canine model with a rapidly growing physis. Arthroscopy 2007; 23 (12) 1309-1319 , e1
    PubMedGoogle Scholar
  • 51 Guzzanti V, Falciglia F, Gigante A, Fabbriciani C. The effect of intra-articular ACL reconstruction on the growth plates of rabbits. J Bone Joint Surg Br 1994; 76 (6) 960-963
    PubMedGoogle Scholar
  • 52 Mäkelä EA, Vainionpää S, Vihtonen K, Mero M, Rokkanen P. The effect of trauma to the lower femoral epiphyseal plate. An experimental study in rabbits. J Bone Joint Surg Br 1988; 70 (2) 187-191
    PubMedGoogle Scholar
  • 53 Seil R, Pape D, Kohn D. The risk of growth changes during transphyseal drilling in sheep with open physes. Arthroscopy 2008; 24 (7) 824-833
    PubMedGoogle Scholar
  • 54 Stadelmaier DM, Arnoczky SP, Dodds J, Ross H ; S.P. The effect of drilling and soft tissue grafting across open growth plates. A histologic study. Am J Sports Med 1995; 23 (4) 431-435
    CrossrefPubMedGoogle Scholar
  • 55 Lykissas MG, Nathan ST, Wall EJ. All-epiphyseal anterior cruciate ligament reconstruction in skeletally immature patients: a surgical technique using a split tibial tunnel. Arthrosc Tech 2012; 1 (1) e133-e139
    CrossrefPubMedGoogle Scholar
  • 56 McCarthy MM, Graziano J, Green DW, Cordasco FA. All-epiphyseal, all-inside anterior cruciate ligament reconstruction technique for skeletally immature patients. Arthrosc Tech 2012; 1 (2) e231-e239
    CrossrefPubMedGoogle Scholar
  • 57 Akinleye SD, Sewick A, Wells L. All-epiphyseal acl reconstruction: a three-year follow-up. Int J Sports Phys Ther 2013; 8 (3) 300-310
    PubMedGoogle Scholar
  • 58 Bonnard C, Fournier J, Babusiaux D, Planchenault M, Bergerault F, de Courtivron B. Physeal-sparing reconstruction of anterior cruciate ligament tears in children: results of 57 cases using patellar tendon. J Bone Joint Surg Br 2011; 93 (4) 542-547
    CrossrefPubMedGoogle Scholar
  • 59 Fabricant PD, Jones KJ, Delos D , et al. Reconstruction of the anterior cruciate ligament in the skeletally immature athlete: a review of current concepts: AAOS exhibit selection. J Bone Joint Surg Am 2013; 95 (5) e28
    CrossrefPubMedGoogle Scholar
  • 60 Liddle AD, Imbuldeniya AM, Hunt DM. Transphyseal reconstruction of the anterior cruciate ligament in prepubescent children. J Bone Joint Surg Br 2008; 90 (10) 1317-1322
    PubMedGoogle Scholar
  • 61 Kumar S, Ahearne D, Hunt DM. Transphyseal anterior cruciate ligament reconstruction in the skeletally immature: follow-up to a minimum of sixteen years of age. J Bone Joint Surg Am 2013; 95 (1) e1
    CrossrefPubMedGoogle Scholar
  • 62 Nikolaou P, Kalliakmanis A, Bousgas D, Zourntos S. Intraarticular stabilization following anterior cruciate ligament injury in children and adolescents. Knee Surg Sports Traumatol Arthrosc 2011; 19 (5) 801-805
    CrossrefPubMedGoogle Scholar
  • 63 Kaeding CC, Flanigan D, Donaldson C. Surgical techniques and outcomes after anterior cruciate ligament reconstruction in preadolescent patients. Arthroscopy 2010; 26 (11) 1530-1538
    CrossrefPubMedGoogle Scholar
  • 64 Shelbourne KD, Gray T, Haro M ; KD Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med 2009; 37 (2) 246-251
    CrossrefPubMedGoogle Scholar
  • 65 Reinhardt KR, Hammoud S, Bowers AL, Umunna BP, Cordasco FA ; KR Revision ACL reconstruction in skeletally mature athletes younger than 18 years. Clin Orthop Relat Res 2012; 470 (3) 835-842
    CrossrefPubMedGoogle Scholar