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The functional outcome of total tears of the anterior cruciate ligament (ACL) in the skeletally immature patient

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Abstract

Tears of the anterior cruciate ligament (ACL) in the skeletally immature patient are becoming more prevalent. The aim of this study was to describe the functional outcome and to evaluate the best management of total tears of the ACL in skeletally immature patient. Twenty consecutive, skeletally immature patients with a clinically evident rupture of the anterior cruciate ligament were followed up for a mean of 5.4 years. The mean age at the time of injury was 13.9 years old. The study group consisted of 13 girls and 7 boys, who were treated either conservatively, by ACL reconstruction, by primary repair or by delayed ACL reconstruction after skeletal maturity had been reached. Clinical outcomes were measured using the International Knee Documentation Committee Scoring System (IKDC) and the Knee Injury and Osteoarthritis Outcome Scoring System (KOOS). The radiological evaluation was performed using Jaeger and Wirth's criteria, and instrumented laxity testing was carried out with a Rolimeter. Five of the eight patients treated conservatively showed poor function of the knee, and this resulted in instability. Concerning the patients treated by primary repair, delayed ACL reconstruction or arthroscopic debridement, we also found none of the results to be satisfactory (seven of eight patients). The patients that were treated by a reconstruction had the best results. This was confirmed by clinical examination (Lachmann grade 1), by the IKDC (grade B) and by the KOOS with the best quality of life and no giving-way attacks. The level of evidence was therapeutic level III.

Résumé

Les ruptures du ligament croisé antérieur chez des jeunes patients qui ne sont pas encore à maturité osseuse deviennent de plus en plus nombreuses. Le but de cette étude est de décrire l’avenir fonctionnel et d’évaluer le meilleur traitement de ces ruptures du croisé antérieur chez des sujets au squelette immature. Vingt patients consécutifs en cours de croissance ayant présenté de façon évidente sur le plan clinique une rupture du ligament croisé antérieur ont été suivis sur une moyenne de 5,4 ans. L’âge moyen au moment du traumatisme était de 13,9 ans. Le groupe étudié consiste en 13 filles et 7 garçons qui ont tous été traités par reconstruction du ligament croisé antérieur de façon immédiate ou, par reconstruction secondaire après fermeture du cartilage de croissance. L’avenir clinique des patients a été étudié selon le score de l’IKDC et du KOOS. L’étude radiologique a utilisée les critères de Jaeger et de Wirth et la laxité a été mesurée avec un Rolimeter. Les patients ont été traités soit par réparation immédiate du ligament croisé antérieur soit par réparation secondaire. Cinq patients (62.5%) traités de façon orthopédique ont montré un résultat clinique médiocre avec une instabilité résiduelle. Les patients traités par réparation primaire ou secondaire du ligament croisé antérieur avec reconstruction ou nettoyage sous arthroscopie non, également pas eu de résultats satisfaisants pour sept d’entre-eux (87.5%). Les patients qui ont été traités par reconstruction ont eu de meilleurs résultats. Ceci a été confirmé cliniquement (Lachmann grade 1), score IKDC (grade B) et le score KOOS avec la meilleure qualité de vie. Niveau d’évidence thérapeutique : niveau III.

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Authors and Affiliations

  1. Department of Traumatology, Medical University of Vienna, Austria, Waehringer Gürtel 18-20, 1090, Vienna, Austria

    Stephanie Arbes, Christoph Resinger, Vilmos Vécsei & Thomas Nau

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  1. Stephanie Arbes
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  2. Christoph Resinger
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  3. Vilmos Vécsei
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  4. Thomas Nau
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Correspondence to Stephanie Arbes.

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Arbes, S., Resinger, C., Vécsei, V. et al. The functional outcome of total tears of the anterior cruciate ligament (ACL) in the skeletally immature patient. International Orthopaedics (SICO 31, 471–475 (2007). https://doi.org/10.1007/s00264-006-0225-5

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  • DOI: https://doi.org/10.1007/s00264-006-0225-5

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