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Management of Anterior Cruciate Ligament Lesion in Adolescents

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Book cover Arthroscopy and Sport Injuries

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Abstract

Anterior cruciate ligament (ACL) lesions in adolescent represent a serious concern for the physician. The increased involvement of children and adolescents in organized sports beginning at an early age raises concern regarding risk and severity of sports injury. Management of ACL injuries is an area of controversy because it can affect long-term growth and recovery as well as the ability to participate in sports. This means children and teenagers who suffer from ACL injuries are likely to face chronic pain and functional limitations from knee osteoarthritis in their 20s and 30s. ACL injury risk in young athletes is likely multifactorial. Injury data from many fields demonstrate that numerous physical and psychological parameters affect ACL injury rates. An accurate understanding of the athlete’s physical maturity by determining skeletal age and Tanner stage helps to identify which treatment is best for a specific patient. Surgery is indicated in skeletally immature patients with a torn ACL and an additional repairable meniscal injury and in patients who failed conservative care, but ACL tear in a youth athlete is not a surgical emergency. Multiple discussions with the athlete and parents may be needed to understand the athlete’s goals and parental expectations and to educate the family about possible treatment options. Pediatricians and orthopedic surgeons who work with schools and sports organizations are encouraged to educate athletes, parents, coaches, and sports administrators about the benefits of neuromuscular training in reducing ACL injuries and direct them to appropriate resources.

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References

  1. Caine D, Purcel L, Maffulli N (2014) The child and adolescent athlete: a review of three potentially serious injuries. Sports Sci Med Rehab 6:22

    Article  Google Scholar 

  2. 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(6):623–628

    Article  PubMed  Google Scholar 

  3. McCarrol JR, Rettig AC, Shelbourne KD (1988) Anterior cruciate ligament injuries in the young athlete with open physes. Am J Sports Med 16(1):44–47

    Article  Google Scholar 

  4. Granan LP, Forssblad M, Lind M, Engebretsen L (2009) The Scandinavian ACL registries 2004–2007: baseline epidemiology. Acta Orthop 80(5):563–567

    Article  PubMed Central  PubMed  Google Scholar 

  5. Renstrom P, Ljungqvist A, Arendt E et al (2008) Non contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med 42(6):394–412

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Comstock R, Collins C, McIlvain N (2013) National High School sports related injury surveillance study. 2009–2010 school year summary. Columbus. www.nationwidechildrens.org/cirp-rio-study-reports. Accessed 28 Feb 2013

  7. Arendt E, Dick R (1995) Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med 23(6):694–701

    Article  CAS  PubMed  Google Scholar 

  8. De Loes M, Dahlstedt LJ, Thomée R (2000) A 7-year study on risks and costs of knee injuries in male and female youth participants in 12 sports. Scand J Med Sci Sports 10(2):90–97

    Article  PubMed  Google Scholar 

  9. Lohmander LS, Englund PM, Dahl LL, Roos EM (2007) The long term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med 35(10):1756–1769

    Article  PubMed  Google Scholar 

  10. Tanner JM, Davies PS (1985) Clinical longitudinal standards for height and height velocity for North American children. J Pediatr 107(3):317–329

    Article  CAS  PubMed  Google Scholar 

  11. Hewett TE, Myer GD, Ford KR (2004) Decrease in neuromuscular control about the knee with maturation in female athletes. JBJS Am 86-A(8):1601–1608

    PubMed  Google Scholar 

  12. Hewett TE, Zazulak BT, Myer GD (2007) Effects of the menstrual cycle on anterior cruciate ligament injury risk: a systematic review. Am J Sports Med 35(4):659–668

    Article  PubMed  Google Scholar 

  13. Myer GD, Ford KR, Hewett TE (2005) The effects of gender on quadriceps muscle activation strategies during a maneuver that mimics a high ACL injury risk position. Electromyogr Kinesiol 15(2):181–189

    Article  Google Scholar 

  14. Nylan JA, Caborn DN, Shapiro R, Johnson DL (1997) Fatigue after eccentric quadriceps femoris work produces earlier gastrocnemius and delayed quadriceps femoris activation during crossover cutting among normal athletic women. Knee Surg Sports Traumatol Arthrosc 5(3):162–167

    Article  Google Scholar 

  15. Shelbourne KD, Davis TJ, Klootwyk TE (1998) The relationship between intercondylar notch width of the femur and the incidence of anterior cruciate ligament tears. A prospective study. Am J Sports Med 26(3):402–408

    CAS  PubMed  Google Scholar 

  16. Lombardo S, Sethi PM, Starkey C (2005) Intercondylar notch stenosis is not a risk factor for anterior cruciate ligament tears in professional male basketball players: an 11-years prospective study. Am J Sports Med 33(1):29–34

    Article  PubMed  Google Scholar 

  17. Trimble MH, Bishop MD, Buckley BD, Fields LC, Rozea GD (2002) The relationship between clinical measurements of lower extremity posture and tibial translation. Clin Biomech 17(4):286–290

    Article  Google Scholar 

  18. Soderman K, Alfredson H, Pietila T, Werner S (2001) Risk factors for leg injuries in female soccer players: a prospective investigation during one out-door season. Knee Surg Sports Traumatol Arthrosc 9(5):313–321

    Article  CAS  PubMed  Google Scholar 

  19. Boden BP, Dean GS, Feagin GA Jr, Garret WE Jr (2000) Mechanism of anterior cruciate ligament injury. Orthopedics 23:573–578

    CAS  PubMed  Google Scholar 

  20. Kocher MS, Saxon HS, Hovis WD, Hawkins RJ (2002) Management and complications of anterior cruciate ligament injuries in skeletally immature patients: survey of Herodicus Society and The ACL study group. J Pediatr Orthop 22:452–457

    PubMed  Google Scholar 

  21. 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 

  22. Kaeding CC, Flanigan D, Donaldson C (2010) Surgical techniques and outcome after anterior cruciate ligament reconstruction in preadolescent patients. Arthroscopy 26:1530–1538

    Article  PubMed  Google Scholar 

  23. Frosch KH, Stengel D, Brodhun T (2010) Outcomes and risks of operative treatment of rupture of anterior cruciate ligament in children and adolescents. Arthroscopy 26(11):1539–1550

    Article  PubMed  Google Scholar 

  24. Kocher MS, Smith JT, Zoric BJ, Lee B, Micheli LJ (2007) Transphyseal anterior cruciate ligament reconstruction in skeletally immature pubescent adolescent. JBJS Am 89(12):2632–2639

    Article  PubMed  Google Scholar 

  25. Volpi P, Galli M, Bait C, Pozzoni R (2004) Surgical treatment of anterior cruciate ligament injuries in adolescents using double-looped semitendinosus and gracilis tendons: supraepiphysary femoral and tibial fixation. Arthroscopy 20(4):447–449

    Article  PubMed  Google Scholar 

  26. Anderson AF (2004) Transepiphyseal replacement of the anterior cruciate ligament using quadruple hamstring grafts in skeletally immature patients. J Bone Joint Surg Am 86-A(pt 2 suppl 1):201–209

    PubMed  Google Scholar 

  27. McCarthy MM, Graziano J, Green DW, Cordasco FA (2012) All epiphyseal, all-inside anterior cruciate ligament reconstruction technique for skeletally immature patients. Arthroscopy Tech 1(2):e231–e239

    Article  Google Scholar 

  28. Lubowitz JH, Schwartzberg R, Smith P (2013) Randomized controlled trial comparing all-inside anterior cruciate ligament reconstruction technique with anterior cruciate ligament reconstruction with a full tibial tunnel. Arthroscopy 29(7):1195–1200

    Article  PubMed  Google Scholar 

  29. 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(7):596–606

    Article  PubMed  Google Scholar 

  30. LaBella CR, Henrikus W, Hewett TE (2014) Anterior cruciate ligament injuries: diagnosis, treatment and prevention. Pediatrics 133:e1437

    Article  PubMed  Google Scholar 

  31. Brief LP (1991) Anterior cruciate ligament reconstruction without drill holes. Arthroscopy 7(4):350–357

    Article  CAS  PubMed  Google Scholar 

  32. Kocher MS, Garg S, Micheli LJ (2006) Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescent. Surgical technique. J Bone Joint Surg Am 88(Pt 2 Suppl 1):283–293

    PubMed  Google Scholar 

  33. Micheli LJ, Rask B, Gerberg L (1999) Anterior cruciate ligament reconstruction in patients who are prepubescent. Clin Orthop Relat Res (364):40–47

    Google Scholar 

  34. Duri ZA, Patel DV, Aichroth PM, (2002) The immature athlete. Clin Sports Med 21(3):461–482

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Unità Operativa di Chirurgia del Ginocchio e Traumatologia dello Sport, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, Milano, 20089, Italy

    Corrado Bait & Matteo Denti

  2. Knee Orthopedics and Sport Traumatology Unit, Humanitas Clinical Institute IRCCS, Milan, Italy

    Piero Volpi

  3. Head of Medical Staff FC Internazionale Milan, Milan, Italy

    Piero Volpi

Authors
  1. Corrado Bait
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  2. Matteo Denti
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  3. Piero Volpi
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Corresponding author

Correspondence to Corrado Bait .

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Editors and Affiliations

  1. Knee Orthopedics and Sport Traumatology Unit,, Humanitas Clinical Institute IRCCS, Milan, Italy

    Piero Volpi

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© 2016 Springer International Publishing Switzerland

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Bait, C., Denti, M., Volpi, P. (2016). Management of Anterior Cruciate Ligament Lesion in Adolescents. In: Volpi, P. (eds) Arthroscopy and Sport Injuries. Springer, Cham. https://doi.org/10.1007/978-3-319-14815-1_48

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  • DOI: https://doi.org/10.1007/978-3-319-14815-1_48

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-14814-4

  • Online ISBN: 978-3-319-14815-1

  • eBook Packages: MedicineMedicine (R0)

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