Skip to main content
SpringerLink
Log in

ACL injuries before 15 years of age: could the young become an athlete?

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to systematically assess the possibility for a patient younger than 15 to return to a competitive level of sport following an ACL injury.

Methods

Four databases were analyzed (PubMed, MedLine, Cinahl, Cochrane Library and LISTA). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used to guide the screening of the literature. Studies about functional and surgical treatments were included with a minimum of 5 years of mean follow-up. Methodological quality of individual studies was assessed with the Methodological Index for Non-Randomized Studies scale.

Results

Ten studies were included, corresponding to a total of 217 patients. All studies were retrospective with level 4 evidence. Seven studies reported results of a transphyseal technique reconstruction, two studies a physeal-sparing reconstruction, and one studied the results of a repair (« healing response »). Only one study compared functional treatment and surgery. The mean age of patients at the time of surgery was 12.29 years (range 2–16) with a mean follow-up of 7.9 years (range 5.5–18.3). Return to sport was possible for 80 to 100% of patients (average of 91.7%) at the final follow-up but the level for return to sport was reported in only four studies and found between 61 and 89% for return to the same level and at 42% for return to a competitive level. Evolution of the Tegner score was analyzed in five studies and was reported to decrease at the follow-up in three studies. ACL re-ruptures can be considered as failure of the graft (nine studies with surgical technique) and occurred with an average of 16%.

Conclusion

This review demonstrate that ACL reconstruction is superior to conservative treatment and 'healing response' in terms of revision rates and knee laxity. Return to sport is possible for more than 4/5 of patients but only two thirds of them were able to return to the same level or to competitive level, and failure rates of the graft were not superior to global population. However, qualities of included studies and variability of treatment limited the clinical application of results. Despite this, patients and parents should be informed that ACL injuries are lesions that may influence the level of sport at a 5-year follow-up.

Level of evidence

Level IV, systematic review.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Dodwell ER, Lamont LE, Green DW, Pan TJ, Marx RG, Lyman S (2014) 20 years of pediatric anterior cruciate ligament reconstruction in New York State. Am J Sports Med 42:675–680. https://doi.org/10.1177/0363546513518412

    Article  PubMed  Google Scholar 

  2. Majewski M, Susanne H, Klaus S (2006) Epidemiology of athletic knee injuries: a 10-year study. Knee 13:184–188. https://doi.org/10.1016/j.knee.2006.01.005

    Article  CAS  PubMed  Google Scholar 

  3. Stracciolini A, Stein CJ, Zurakowski D, Meehan WP, Myer GD, Micheli LJ (2015) Anterior cruciate ligament injuries in pediatric athletes presenting to sports medicine clinic: a comparison of males and females through growth and development. Sports Health 7:130–136. https://doi.org/10.1177/1941738114554768

    Article  PubMed  PubMed Central  Google Scholar 

  4. Werner BC, Yang S, Looney AM, Gwathmey FW (2016) Trends in pediatric and adolescent anterior cruciate ligament injury and reconstruction. J Pediatr Orthop 36:447–452. https://doi.org/10.1097/BPO.0000000000000482

    Article  PubMed  Google Scholar 

  5. Brophy RH, Stepan JG, Silvers HJ, Mandelbaum BR (2015) Defending puts the anterior cruciate ligament at risk during soccer: a gender-based analysis. Sports Health 7:244–249. https://doi.org/10.1177/1941738114535184

    Article  PubMed  PubMed Central  Google Scholar 

  6. Morgan MD, Salmon LJ, Waller A, Roe JP, Pinczewski LA (2016) Fifteen-year survival of endoscopic anterior cruciate ligament reconstruction in patients aged 18 years and younger. Am J Sports Med 44:384–392. https://doi.org/10.1177/0363546515623032

    Article  PubMed  Google Scholar 

  7. Krutsch W, Zellner J, Baumann F, Pfeifer C, Nerlich M, Angele P (2017) Timing of anterior cruciate ligament reconstruction within the first year after trauma and its influence on treatment of cartilage and meniscus pathology. Knee Surg Sports Traumatol Arthrosc 25:418–425. https://doi.org/10.1007/s00167-015-3830-2

    Article  PubMed  Google Scholar 

  8. Wong SE, Feeley BT, Pandya NK (2019) Complications after pediatric ACL reconstruction: a meta-analysis. J Pediatr Orthop 39:e566–e571. https://doi.org/10.1097/BPO.0000000000001075

    Article  PubMed  Google Scholar 

  9. Faunø P, Rahr-Wagner L, Lind M (2014) Risk for revision after anterior cruciate ligament reconstruction is higher among adolescents: results from the danish registry of knee ligament reconstruction. Orthop J Sports Med 2:2325967114552405. https://doi.org/10.1177/2325967114552405

    Article  PubMed  PubMed Central  Google Scholar 

  10. Webster KE, Feller JA, Leigh WB, Richmond AK (2014) Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction. Am J Sports Med 42:641–647. https://doi.org/10.1177/0363546513517540

    Article  PubMed  Google Scholar 

  11. Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD (2016) Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med 44:1861–1876. https://doi.org/10.1177/0363546515621554

    Article  PubMed  PubMed Central  Google Scholar 

  12. Aronowitz ER, Ganley TJ, Goode JR, Gregg JR, Meyer JS (2000) Anterior cruciate ligament reconstruction in adolescents with open physes. Am J Sports Med 28:168–175. https://doi.org/10.1177/03635465000280020601

    Article  CAS  PubMed  Google Scholar 

  13. Graf BK, Lange RH, Fujisaki CK, Landry GL, Saluja RK (1992) Anterior cruciate ligament tears in skeletally immature patients: meniscal pathology at presentation and after attempted conservative treatment. Arthroscopy 8:229–233. https://doi.org/10.1016/0749-8063(92)90041-9

    Article  CAS  PubMed  Google Scholar 

  14. Ardern CL, Taylor NF, Feller JA, Webster KE (2014) Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 48:1543–1552. https://doi.org/10.1136/bjsports-2013-093398

    Article  PubMed  Google Scholar 

  15. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716. https://doi.org/10.1046/j.1445-2197.2003.02748.x

    Article  PubMed  Google Scholar 

  16. Bonnard C, Fournier J, Babusiaux D, Planchenault M, Bergerault F, de Courtivron B (2011) Physeal-sparing reconstruction of anterior cruciate ligament tears in children: results of 57 cases using patellar tendon. J Bone Joint Surg Br 93:542–547. https://doi.org/10.1302/0301-620X.93B4.25801

    Article  CAS  PubMed  Google Scholar 

  17. Placella G, Bartoli M, Peruzzi M, Speziali A, Pace V, Cerulli G (2016) Return to sport activity after anterior cruciate ligament reconstruction in skeletally immature athletes with manual drilling original all inside reconstruction at 8 years follow-up. Acta Orthop Traumatol Turc 50:635–638. https://doi.org/10.1016/j.aott.2016.03.006

    Article  PubMed  PubMed Central  Google Scholar 

  18. Calvo R, Figueroa D, Gili F, Vaisman A, Mocoçain P, Espinosa M et al (2015) Transphyseal anterior cruciate ligament reconstruction in patients with open physes: 10-year follow-up study. Am J Sports Med 43:289–294. https://doi.org/10.1177/0363546514557939

    Article  PubMed  Google Scholar 

  19. Demange MK, Camanho GL (2014) Nonanatomic anterior cruciate ligament reconstruction with double-stranded semitendinosus grafts in children with open physes: minimum 15-year follow-up. Am J Sports Med 42:2926–2932. https://doi.org/10.1177/0363546514550981

    Article  PubMed  Google Scholar 

  20. Streich NA, Barié A, Gotterbarm T, Keil M, Schmitt H (2010) Transphyseal reconstruction of the anterior cruciate ligament in prepubescent athletes. Knee Surg Sports Traumatol Arthrosc 18:1481–1486. https://doi.org/10.1007/s00167-010-1057-9

    Article  PubMed  Google Scholar 

  21. Kumar S, Ahearne D, Hunt DM (2013) Transphyseal anterior cruciate ligament reconstruction in the skeletally immature: follow-up to a minimum of sixteen years of age. J Bone Joint Surg Am 95:e1. https://doi.org/10.2106/JBJS.K.01707

    Article  PubMed  Google Scholar 

  22. Lo IK, Kirkley A, Fowler PJ, Miniaci A (1997) The outcome of operatively treated anterior cruciate ligament disruptions in the skeletally immature child. Arthroscopy 13:627–634. https://doi.org/10.1016/s0749-8063(97)90191-2

    Article  CAS  PubMed  Google Scholar 

  23. Micheli LJ, Rask B, Gerberg L (1999) Anterior cruciate ligament reconstruction in patients who are prepubescent. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-199907000-00006

    Article  PubMed  Google Scholar 

  24. Steadman JR, Cameron-Donaldson ML, Briggs KK, Rodkey WG (2006) A minimally invasive technique (“healing response”) to treat proximal ACL injuries in skeletally immature athletes. J Knee Surg 19:8–13. https://doi.org/10.1055/s-0030-1248070

    Article  PubMed  Google Scholar 

  25. Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 45:596–606. https://doi.org/10.1136/bjsm.2010.076364

    Article  PubMed  Google Scholar 

  26. Kvist J (2004) Rehabilitation following anterior cruciate ligament injury: current recommendations for sports participation. Sports Med 34:269–280. https://doi.org/10.2165/00007256-200434040-00006

    Article  PubMed  Google Scholar 

  27. Kvist J, Ek A, Sporrstedt K, Good L (2005) Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 13:393–397. https://doi.org/10.1007/s00167-004-0591-8

    Article  PubMed  Google Scholar 

  28. Frank JS, Gambacorta PL (2013) Anterior cruciate ligament injuries in the skeletally immature athlete: diagnosis and management. J Am Acad Orthop Surg 21:78–87. https://doi.org/10.5435/JAAOS-21-02-78

    Article  PubMed  Google Scholar 

  29. Edwards PH, Grana WA (2001) Anterior cruciate ligament reconstruction in the immature athlete: long-term results of intra-articular reconstruction. Am J Knee Surg 14:232–237

    CAS  PubMed  Google Scholar 

  30. Holwein C, Hinterwimmer S, Mayr HO, Lämmle L, Brucker PU, Münch EO et al (2016) Functional outcome after transphyseal anterior cruciate ligament reconstruction in young patients with open growth plates. Knee 23:1121–1132. https://doi.org/10.1016/j.knee.2016.09.001

    Article  CAS  PubMed  Google Scholar 

  31. Larson CM, Heikes CS, Ellingson CI, Wulf CA, Giveans MR, Stone RM et al (2016) Allograft and autograft transphyseal anterior cruciate ligament reconstruction in skeletally immature patients: outcomes and complications. Arthroscopy 32:860–867. https://doi.org/10.1016/j.arthro.2015.10.014

    Article  PubMed  Google Scholar 

  32. McCullough KA, Phelps KD, Spindler KP, Matava MJ, Dunn WR, Parker RD et al (2012) Return to high school- and college-level football after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) cohort study. Am J Sports Med 40:2523–2529. https://doi.org/10.1177/0363546512456836

    Article  PubMed  PubMed Central  Google Scholar 

  33. Nikolaou P, Kalliakmanis A, Bousgas D, Zourntos S (2011) Intraarticular stabilization following anterior cruciate ligament injury in children and adolescents. Knee Surg Sports Traumatol Arthrosc 19:801–805. https://doi.org/10.1007/s00167-010-1375-y

    Article  PubMed  Google Scholar 

  34. Shea KG, Pfeiffer R, Wang JH, Curtin M, Apel PJ (2004) Anterior cruciate ligament injury in pediatric and adolescent soccer players: an analysis of insurance data. J Pediatr Orthop 24:623–628. https://doi.org/10.1097/00004694-200411000-00005

    Article  PubMed  Google Scholar 

  35. Johnston DR, Ganley TJ, Flynn JM, Gregg JR (2002) Anterior cruciate ligament injuries in skeletally immature patients. Orthopedics 25:864–871

    PubMed  Google Scholar 

  36. Millett PJ, Willis AA, Warren RF (2002) Associated injuries in pediatric and adolescent anterior cruciate ligament tears: does a delay in treatment increase the risk of meniscal tear? Arthroscopy 18:955–959. https://doi.org/10.1053/jars.2002.36114

    Article  PubMed  Google Scholar 

  37. Mizuta H, Kubota K, Shiraishi M, Otsuka Y, Nagamoto N, Takagi K (1995) The conservative treatment of complete tears of the anterior cruciate ligament in skeletally immature patients. J Bone Joint Surg Br 77:890–894

    Article  CAS  PubMed  Google Scholar 

  38. Pressman AE, Letts RM, Jarvis JG (1997) Anterior cruciate ligament tears in children: an analysis of operative versus nonoperative treatment. J Pediatr Orthop 17:505–511

    CAS  PubMed  Google Scholar 

  39. Kay J, Memon M, Marx RG, Peterson D, Simunovic N, Ayeni OR (2018) 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 26:1019–1036. https://doi.org/10.1007/s00167-018-4830-9

    Article  PubMed  Google Scholar 

  40. Kay J, Memon M, Shah A, Yen Y-M, Samuelsson K, Peterson D et al (2018) 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 26:3738–3753. https://doi.org/10.1007/s00167-018-5012-5

    Article  PubMed  Google Scholar 

  41. Barrett AM, Craft JA, Replogle WH, Hydrick JM, Barrett GR (2011) Anterior cruciate ligament graft failure: a comparison of graft type based on age and Tegner activity level. Am J Sports Med 39:2194–2198. https://doi.org/10.1177/0363546511415655

    Article  PubMed  Google Scholar 

  42. Bourke HE, Gordon DJ, Salmon LJ, Waller A, Linklater J, Pinczewski LA (2012) The outcome at 15 years of endoscopic anterior cruciate ligament reconstruction using hamstring tendon autograft for “isolated” anterior cruciate ligament rupture. J Bone Joint Surg Br 94:630–637. https://doi.org/10.1302/0301-620X.94B5.28675

    Article  CAS  PubMed  Google Scholar 

  43. Shelbourne KD, Gray T, Haro M (2009) Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med 37:246–251. https://doi.org/10.1177/0363546508325665

    Article  PubMed  Google Scholar 

  44. Anderson AF, Anderson CN (2015) Correlation of meniscal and articular cartilage injuries in children and adolescents with timing of anterior cruciate ligament reconstruction. Am J Sports Med 43:275–281. https://doi.org/10.1177/0363546514559912

    Article  PubMed  Google Scholar 

  45. Dumont GD, Hogue GD, Padalecki JR, Okoro N, Wilson PL (2012) Meniscal and chondral injuries associated with pediatric anterior cruciate ligament tears: relationship of treatment time and patient-specific factors. Am J Sports Med 40:2128–2133. https://doi.org/10.1177/0363546512449994

    Article  PubMed  Google Scholar 

  46. Guenther ZD, Swami V, Dhillon SS, Jaremko JL (2014) Meniscal injury after adolescent anterior cruciate ligament injury: how long are patients at risk? Clin Orthop Relat Res 472:990–997. https://doi.org/10.1007/s11999-013-3369-9

    Article  PubMed  Google Scholar 

  47. Lawrence JTR, Argawal N, Ganley TJ (2011) 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 39:2582–2587. https://doi.org/10.1177/0363546511420818

    Article  PubMed  Google Scholar 

  48. Goddard M, Bowman N, Salmon LJ, Waller A, Roe JP, Pinczewski LA (2013) Endoscopic anterior cruciate ligament reconstruction in children using living donor hamstring tendon allografts. Am J Sports Med 41:567–574. https://doi.org/10.1177/0363546512473576

    Article  PubMed  Google Scholar 

Download references

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Clinique du Sport de Bordeaux Mérignac, 4 rue Georges Negrevergne, 33700, Mérignac, France

    Antoine Morvan, Nicolas Bouguennec & Nicolas Graveleau

Authors
  1. Antoine Morvan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicolas Bouguennec
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicolas Graveleau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antoine Morvan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morvan, A., Bouguennec, N. & Graveleau, N. ACL injuries before 15 years of age: could the young become an athlete?. Arch Orthop Trauma Surg 140, 1055–1063 (2020). https://doi.org/10.1007/s00402-020-03404-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-020-03404-8

Keywords

Search

Navigation