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ACL Injuries in Skeletally Immature and Adolescents Patients: How Can We Improve the High Rate of Poor Outcomes?

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The ACL-Deficient Knee

Abstract

Currently, it is estimated that 400,000 anterior cruciate ligament (ACL) surgeries are performed in the USA. About half of those patients are children and adolescents [26, 65]. The most common injury patterns are midsubstance tears or tibial eminence avulsions. Treatment of a tibial eminence avulsion is done with closed reduction and immobilization (Meyers and McKeever types I and II) or refixation with sutures, pins, or screws (type III) and will not be discussed in this chapter.

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References

  1. Abernethy L, Bleakley C. Strategies to prevent injury in adolescent sport: a systematic review. Br J Sports Med. 2007;10:627–38.

    Article  Google Scholar 

  2. Aichroth P, Patel D, 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. 2002;84-B:38–41.

    Article  Google Scholar 

  3. Anderson A. Transepiphyseal replacement of the anterior cruciate ligament in skeletally immature patients. A preliminary report. J Bone Joint Surg. 2003;85-A:1255–63.

    PubMed  Google Scholar 

  4. Andrews M, Noyes F, Barber-Westin S. Anterior cruciate ligament allograft reconstruction in the skeletally immature athlete. Am J Sports Med. 1994;22:48–54.

    Article  PubMed  CAS  Google Scholar 

  5. Angel K, Hall D. Anterior cruciate ligament injury in children and adolescents. Arthroscopy. 1989;5:197–200.

    Article  PubMed  CAS  Google Scholar 

  6. Arbes S, Resinger C, Vecsei V, et al. The functional outcome of total tears of the anterior cruciate ligament (ACL) in the skeletally immature patient. Int Orthop. 2007;31:471–5.

    Article  PubMed  Google Scholar 

  7. Aronowitz E, Ganley T, Goode J, et al. Anterior cruciate ligament reconstruction in adolescents with open physes. Am J Sports Med. 2000;28:168–75.

    PubMed  CAS  Google Scholar 

  8. Attmanspacher W, Dittrich V, Stedtfeld H. results on treatment of anterior cruciate ligament rupture of immature and adolescents. Unfallchirurg. 2003;106:136–43.

    Article  PubMed  CAS  Google Scholar 

  9. Bollen S, Pease F, Ehrenraich A, et al. Changes in the four-strand hamstring graft in anterior cruciate ligament reconstruction in the skeletally-immature knee. J Bone Joint Surg. 2008;90-B:455–9.

    Article  Google Scholar 

  10. Brief L. Anterior cruciate ligament reconstruction without drill holes. Arthroscopy. 1991;7:350–7.

    Article  PubMed  CAS  Google Scholar 

  11. Chudik S, Beasley L, Potter H, et al. 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;23:1309–1319.e1.

    Article  PubMed  Google Scholar 

  12. Cohen M, Ferretti M, Quarteiro M, et al. Trans­physeal anterior cruciate ligament reconstruction in patients with open physes. Arthroscopy. 2009;25:831–8.

    Article  PubMed  Google Scholar 

  13. Edwards P, Grana W. Anterior cruciate ligament reconstruction in the immature athlete: long-term results of intra-articular reconstruction. Am J Knee Surg. 2001;14:232–7.

    PubMed  CAS  Google Scholar 

  14. 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. 2001;83-A:725–34.

    PubMed  CAS  Google Scholar 

  15. 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;26:1539–50.

    Article  PubMed  Google Scholar 

  16. Fuchs R, Wheatley W, Uribe J, et al. Intra-articular anterior cruciate ligament reconstruction using patellar tendon allograft in the skeletally immature patient. Arthroscopy. 2002;18:824–8.

    Article  PubMed  Google Scholar 

  17. Gebhard F, Ellermann A, Hoffmann F, et al. 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;14:797–803.

    Article  PubMed  CAS  Google Scholar 

  18. Gorin S, Paul DD, Wilkinson EJ. An anterior cruciate ligament and medial collateral ligament tear in a skeletally immature patient: a new technique to augment primary repair of the medial collateral ligament and an allograft reconstruction of the anterior cruciate ligament. Arthroscopy. 2003;19:E21–6.

    PubMed  Google Scholar 

  19. Graf B, Lange R, Fujisaki C, et al. Anterior cruciate ligament tears in skeletally immature patients: ­meniscal pathology at presentation and after attempted conservative treatment. Arthroscopy. 1992;8:229–33.

    Article  PubMed  CAS  Google Scholar 

  20. Guzzanti V, Falciglia F, Stanitski C. Preoperative evaluation and anterior cruciate ligament reconstruction technique for skeletally immature patients in tanner stages 2 and 3. Am J Sports Med. 2003;31:941–8.

    PubMed  Google Scholar 

  21. Guzzanti V, Falciglia F, Stanitski C. Physeal-sparing intraarticular anterior cruciate ligament reconstruction in preadolescents. Am J Sports Med. 2003;31:949–53.

    PubMed  Google Scholar 

  22. 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;17:748–55.

    Article  PubMed  Google Scholar 

  23. Higuchi T, Hara K, Tsuji Y, et al. Transepiphyseal reconstruction of the anterior cruciate ligament in skeletally immature athletes: an MRI evaluation for epiphyseal narrowing. J Pediatr Orthop B. 2009;18:330–4.

    Article  PubMed  Google Scholar 

  24. Houle JB, Letts M, Yang J. Effects of a tensioned tendon graft in a bone tunnel across the rabbit physis. Clin Orthop Relat Res. 2001;391:275–81.

    Article  PubMed  Google Scholar 

  25. Janarv P, Nystrom A, Werner S, et al. Anterior cruciate ligament injuries in skeletally immature patients. J Pediatr Orthop. 1996;16:673–7.

    Article  PubMed  CAS  Google Scholar 

  26. Kaeding CC, Flanigan D, Donaldson C. Surgical techniques and outcomes after anterior cruciate ligament reconstruction in preadolescent patients. Arthroscopy. 2010;26:1530–8.

    Article  PubMed  Google Scholar 

  27. Kocher M, Saxon H, Hovis W, 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;22:452–7.

    PubMed  Google Scholar 

  28. 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. 2005;87-A:2371–9.

    Article  Google Scholar 

  29. Kocher M, Garg S, Micheli L. Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescents. Surgical technique. J Bone Joint Surg. 2006;88-A(Suppl 1 Pt 2):283–93.

    Google Scholar 

  30. Kocher MS, Smith JT, Zoric BJ, et al. Transphyseal anterior cruciate ligament reconstruction in skeletally immature pubescent adolescents. J Bone Joint Surg. 2007;89-A:2632–9.

    Article  Google Scholar 

  31. Koman J, Sanders J. Valgus deformity after reconstruction of the anterior cruciate ligament in a skeletally immature patient. A case report. J Bone Joint Surg. 1999;81-A:711–5.

    Google Scholar 

  32. Liddle AD, Imbuldeniya AM, Hunt DM. Transphyseal reconstruction of the anterior cruciate ligament in prepubescent children. J Bone Joint Surg. 2008;90-B:1317–22.

    Article  Google Scholar 

  33. Lipscomb A, Anderson A. Tears of the anterior cruciate ligament in adolescents. J Bone Joint Surg. 1986;68-A:19–28.

    Google Scholar 

  34. Lo IK, Kirkley A, Fowler PJ, et al. The outcome of operatively treated anterior cruciate ligament disruptions in the skeletally immature child. Arthroscopy. 1997;13:627–34.

    Article  PubMed  CAS  Google Scholar 

  35. Marx A, Siebold R, Sobau C, et al. ACL reconstruction in skeletally immature patients. Z Orthop Unfall. 2008;146:715–9.

    Article  PubMed  CAS  Google Scholar 

  36. Mastrangelo A, Haus B, Vavken P, et al. Immature animals have denser anterior cruciate ligament wound site cell repopulation than adolescent or adult animals. J Orthop Res. 2010;28:1100–6.

    PubMed  Google Scholar 

  37. Mastrangelo A, Magarian E, Palmer M, et al. The effect of skeletal maturity on the regenerative function of intrinsic ACL cells. J Orthop Res. 2010;28:644–51.

    PubMed  Google Scholar 

  38. Matava MJ, Siegel MG. Arthroscopic reconstruction of the ACL with semitendinosus-gracilis autograft in skeletally immature adolescent patients. Am J Knee Surg. 1997;10:60–9.

    PubMed  CAS  Google Scholar 

  39. McCarroll JR, Rettig AC, Shelbourne KD. Anterior cruciate ligament injuries in the young athlete with open physes. Am J Sports Med. 1988;16:44–7.

    Article  PubMed  CAS  Google Scholar 

  40. McCarroll J, Shelbourne KD, Porter D, 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;22:478–84.

    Article  PubMed  CAS  Google Scholar 

  41. McIntosh AL, Dahm DL, Stuart MJ. Anterior cruciate ligament reconstruction in the skeletally immature patient. Arthroscopy. 2006;22:1325–30.

    Article  PubMed  Google Scholar 

  42. Micheli L, Rask B, Gerberg L. Anterior cruciate ­ligament reconstruction in patients who are prepubescent. Clin Orthop Relat Res. 1999;364:40–7.

    Article  PubMed  Google Scholar 

  43. 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. 1995;77-B:890–4.

    Google Scholar 

  44. Murray M, Spindler K. Anterior cruciate ligament healing and repair. Sports Med Arthrosc Rev. 2005;13:151–5.

    Article  Google Scholar 

  45. Murray MM. Current status and potential of primary ACL repair. Clin Sports Med. 2009;28:51–61.

    Article  PubMed  Google Scholar 

  46. Parker A, Drez DJ, Cooper J. Anterior cruciate ligament injuries in patients with open physes. Am J Sports Med. 1994;22:44–7.

    Article  PubMed  CAS  Google Scholar 

  47. Pressman AE, Letts RM, Jarvis JG. Anterior cruciate ligament tears in children: an analysis of operative versus nonoperative treatment. J Pediatr Orthop. 1997;17:505–11.

    PubMed  CAS  Google Scholar 

  48. Robert H, Bonnard C. The possibilities of using the patellar tendon in the treatment of anterior cruciate ligament tears in children. Arthroscopy. 1999;15:73–6.

    Article  PubMed  CAS  Google Scholar 

  49. Sadoghi P, von Keudell A, Vavken P. Effectiveness of anterior cruciate ligament injury prevention training programs. J Bone Joint Surg Am. 2012;94(9):769–76

    Article  PubMed  Google Scholar 

  50. Salzmann GM, Spang JT, Imhoff AB. Double-bundle anterior cruciate ligament reconstruction in a ­skeletally immature adolescent athlete. Arthroscopy. 2009;25:321–4.

    Article  PubMed  Google Scholar 

  51. Schneider FJ, Kraus T, Linhart WE. anterior cruciate ligament reconstruction with semitendinosus tendon in children. Oper Orthop Traumatol. 2008;20:409–22.

    Article  PubMed  Google Scholar 

  52. Seil R, Pape D, Kohn D. The risk of growth changes during transphyseal drilling in sheep with open physes. Arthroscopy. 2008;24:824–33.

    Article  PubMed  Google Scholar 

  53. Seon JK, Song EK, Yoon TR, et al. Transphyseal reconstruction of the anterior cruciate ligament using hamstring autograft in skeletally immature adolescents. J Korean Med Sci. 2005;20:1034–8.

    Article  PubMed  Google Scholar 

  54. Shea KG, Apel PJ, Pfeiffer RP. Anterior cruciate ligament injury in paediatric and adolescent patients: a review of basic science and clinical research. Sports Med. 2003;33:455–71.

    Article  PubMed  Google Scholar 

  55. Shea KG, Apel PJ, Pfeiffer RP, et al. The anatomy of the proximal tibia in pediatric and adolescent patients: implications for ACL reconstruction and prevention of physeal arrest. Knee Surg Sports Traumatol Arthrosc. 2007;15:320–7.

    Article  PubMed  Google Scholar 

  56. Shelbourne KD, Patel DV, McCarroll JR. Management of anterior cruciate ligament injuries in skeletally immature adolescents. Knee Surg Sports Traumatol Arthrosc. 1996;4:68–74.

    Article  PubMed  CAS  Google Scholar 

  57. Shelbourne KD, Gray T, Wiley BV. Results of transphyseal anterior cruciate ligament reconstruction using patellar tendon autograft in tanner stage 3 or 4 adolescents with clearly open growth plates. Am J Sports Med. 2004;32:1218–22.

    Article  PubMed  Google Scholar 

  58. Sobau C, Ellermann A. anterior cruciate ligament reconstruction with hamstring tendons in the young. Unfallchirurg. 2004;107:676–9.

    PubMed  CAS  Google Scholar 

  59. 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;23:431–5.

    Article  PubMed  CAS  Google Scholar 

  60. Steadman JR, Cameron-Donaldson ML, Briggs KK, et al. A minimally invasive technique (“Healing response”) to treat proximal ACL injuries in skeletally immature athletes. J Knee Surg. 2006;19:8–13.

    PubMed  Google Scholar 

  61. Streich NA, Barie A, Gotterbarm T, et al. Transphyseal reconstruction of the anterior cruciate ligament in prepubescent athletes. Knee Surg Sports Traumatol Arthrosc. 2010;18:1481–6.

    Article  PubMed  Google Scholar 

  62. Tanner J, Davies P. Clincial longitudinal standards for height and height velocity for north american children. J Pediatr Orthop. 1985;107:317–29.

    CAS  Google Scholar 

  63. Vavken P, Murray MM. Translational studies in ACL repair. Tissue Eng Part B Rev. 2010;16(1):5–11.

    Article  PubMed  Google Scholar 

  64. Vavken P, Murray MM. Translational studies in anterior cruciate ligament repair. Tissue Eng Part B Rev. 2010;16:5–11.

    Article  PubMed  Google Scholar 

  65. Vavken P, Murray MM. The potential for primary repair of the ACL. Sports Med Arthrosc. 2011;19:44–9.

    Article  PubMed  Google Scholar 

  66. Vavken P, Murray M. Treating anterior cruciate ligament tears in skeletally immature patients. Arthroscopy. 2011;27:704–16.

    Article  PubMed  Google Scholar 

  67. Vavken P, Sadoghi P, Murray M. The effect of platelet concentrates on graft maturation and graft-bone interface healing in anterior cruciate ligament ­reconstruction in human patients: a systematic review of controlled trials. Arthroscopy. 2011;27:1573–83.

    Article  PubMed  Google Scholar 

  68. Wester W, Canale ST, Dutkowsky JP, et al. Prediction of angular deformity and leg-length discrepancy after anterior cruciate ligament reconstruction in skeletally immature patients. J Pediatr Orthop. 1994;14:516–21.

    Article  PubMed  CAS  Google Scholar 

  69. Woods GW, O’Connor DP. Delayed anterior cruciate ligament reconstruction in adolescents with open physes. Am J Sports Med. 2004;32:201–10.

    Article  PubMed  Google Scholar 

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Correspondence to Patrick Vavken M.D., M.Sc. .

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Vavken, P., Micheli, L.J., Murray, M.M. (2013). ACL Injuries in Skeletally Immature and Adolescents Patients: How Can We Improve the High Rate of Poor Outcomes?. In: Sanchis-Alfonso, V., Monllau, J. (eds) The ACL-Deficient Knee. Springer, London. https://doi.org/10.1007/978-1-4471-4270-6_12

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