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Anterior Cruciate Ligament Injury in Pediatric Population

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Orthopaedic Sports Medicine

Abstract

The high rate of anterior cruciate ligament injury in the skeletally immature population highlights the need for literature focusing specifically on this population. The presence of an open physis presents a unique challenge to surgeons planning anterior cruciate reconstruction not encountered in the skeletally mature patient population. Consideration of several patient characteristics is vital to properly plan treatment of these patients, minimize complications, and provide the best possible outcome. The treatment algorithm suggested in this chapter categorizes patients into 4 groups based on patient characteristics and injury mechanisms, which can help define the best therapeutic approach.

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References

  1. Perkins CA, Willimon SC. Pediatric anterior cruciate ligament reconstruction. Orthop Clin North Am. 2020;51:55–63.

    Article  PubMed  Google Scholar 

  2. Bram JT, Magee LC, Mehta NN, Patel NM, Ganley TJ. Anterior cruciate ligament injury incidence in adolescent athletes: a systematic review and meta-analysis. Am J Sports Med. 2021;49(7):1962–72.

    Article  PubMed  Google Scholar 

  3. Gornitzky AL, Lott A, Yellin JL, Fabricant PD, Lawrence JT, Ganley TJ. Sport-specific yearly risk and incidence of anterior cruciate ligament tears in high school athletes: a systematic review and meta-analysis. Am J Sports Med. 2016;44:2716–23.

    Article  PubMed  Google Scholar 

  4. Mall NA, Paletta GA. Pediatric ACL injuries: evaluation and management. Curr Rev Musculoskelet Med. 2013;6(2):132–40. https://doi.org/10.1007/s12178-013-9169-8. PMID: 23575620; PMCID: PMC3702779.

  5. Anderson M, Green WT, Messner MB. Growth and predictions of growth in the lower extremities. J Bone Joint Surg Am. 1963;45-A:1–14.

    Article  CAS  PubMed  Google Scholar 

  6. Kelly PM, Diméglio A. Lower-limb growth: how predictable are predictions? J Child Orthop. 2008;2:407–15.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Fabricant PD, Kocher MS. Anterior cruciate ligament injuries in children and adolescents. Orthop Clin North Am. 2016;47:777–88.

    Article  PubMed  Google Scholar 

  8. Fabricant PD, Kocher MS. Management of ACL injuries in children and adolescents. J Bone Joint Surg Am. 2017;99:600–12.

    Article  PubMed  Google Scholar 

  9. Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lázaro-Haro C, Cugat R. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc. 2009;17(7):705–29.

    Article  PubMed  Google Scholar 

  10. Trivedi V, Mishra P, Verma D. Pediatric ACL injuries: a review of current concepts. Open Orthop J. 2017;11:378–88.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ardern CL, Ekås G, Grindem H, et al. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. Knee Surg Sports Traumatol Arthrosc. 2018;26:989–1010.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Astur DC, Castro S, Bernardes A, Cohen M. Unusual case of a surgically treated ACL tear in a 4-year-old patient. BMJ Case Rep. 2015;2015:bcr2015210817.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hewett TE, Myer GD, Ford KR. Anterior cruciate ligament injuries in female athletes: Part 1, mechanisms and risk factors. Am J Sports Med. 2006;34:299–311.

    Article  PubMed  Google Scholar 

  14. Frank JS, Gambacorta PL. Anterior cruciate ligament injuries in the skeletally immature athlete: diagnosis and management. J Am Acad Orthop Surg. 2013;21:78–87.

    Article  PubMed  Google Scholar 

  15. Lee K, Siegel MJ, Lau DM, Hildebolt CF, Matava MJ. Anterior cruciate ligament tears: MR imaging-based diagnosis in a pediatric population. Radiology. 1999;213(3):697–704.

    Article  CAS  PubMed  Google Scholar 

  16. Boden BP, Dean GS, Feagin JA Jr, Garrett WE Jr. Mechanisms of anterior cruciate ligament injury. Orthopedics. 2000;23:573–8.

    Article  CAS  PubMed  Google Scholar 

  17. Astur DC, Novaretti JV, Cavalcante ELB, et al. Pediatric anterior cruciate ligament reruptures are related to lower functional scores at the time of return to activity: a prospective, midterm follow-up study. Orthop J Sports Med. 2019;7:2325967119888888. https://doi.org/10.1177/2325967119888888.

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  19. Brief LP. Anterior cruciate ligament injuries in patients with open physes. Am J Sports Med. 1994;22:569.

    Article  CAS  PubMed  Google Scholar 

  20. Davis DL, Chen L, Young ST. Evaluation of epiphyses in the skeletally immature knee using magnetic resonance imaging: a pilot study to analyze parameters for anterior cruciate ligament reconstruction. Am J Sports Med. 2013;41:1579–85.

    Article  PubMed  Google Scholar 

  21. Davis DL, Chen L, Ehinger M. A study of epiphyses in the young prepubescent knee using magnetic resonance imaging: evaluation of parameters for anterior cruciate ligament reconstruction. Orthop J Sports Med. 2014;2:2325967114530090.

    PubMed  PubMed Central  Google Scholar 

  22. Davis DL, Almardawi R, Mitchell JW. Analysis of the tibial epiphysis in the skeletally immature knee using magnetic resonance imaging: an update of anatomic parameters pertinent to physeal-sparing anterior cruciate ligament reconstruction. Orthop J Sports Med. 2016;4:2325967116655313. https://doi.org/10.1177/2325967116655313.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Stonestreet MJ, Jones KC, Kirkpatrick MS, et al. All-epiphyseal ACL reconstruction improves tibiofemoral contact: an in vitro study. J Pediatr Orthop. 2012;32:15–20.

    Article  PubMed  Google Scholar 

  24. DeFrancesco CJ, Storey EP, Shea KG, Kocher MS, Ganley TJ. Challenges in the management of anterior cruciate ligament ruptures in skeletally immature patients. J Am Acad Orthop Surg. 2018;26:e50–61.

    Article  PubMed  Google Scholar 

  25. Willson RG, Kostyun RO, Milewski MD, Nissen CW. Anterior cruciate ligament reconstruction in skeletally immature patients: early results using a hybrid physeal-sparing technique. Orthop J Sports Med. 2018;6:2325967118755330. https://doi.org/10.1177/2325967118755330.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Calvo R, Figueroa D, Gili F, et al. Transphyseal anterior cruciate ligament reconstruction in patients with open physes: 10-year follow-up study. Am J Sports Med. 2015;43:289–94.

    Article  PubMed  Google Scholar 

  27. Collins MJ, Arns TA, Leroux T, et al. Growth abnormalities following anterior cruciate ligament reconstruction in the skeletally immature patient: a systematic review. Arthroscopy. 2016;32:1714–23.

    Article  PubMed  Google Scholar 

  28. Wong SE, Feeley BT, Pandya NK. Complications after pediatric ACL reconstruction: a meta-analysis. J Pediatr Orthop. 2019;39(8):e566–71.

    Article  PubMed  Google Scholar 

  29. Lawrence JT, Argawal N, Ganley TJ. 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. 2011;39:2582–7.

    Article  PubMed  Google Scholar 

  30. 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;18:955–9.

    Article  PubMed  Google Scholar 

  31. 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;22:452–7.

    Article  PubMed  Google Scholar 

  32. Anderson CN, Anderson AF. Management of the anterior cruciate ligament-injured knee in the skeletally immature athlete. Clin Sports Med. 2017;36:35–52.

    Article  PubMed  Google Scholar 

  33. Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med. 2016;44(7):1861–76.

    Article  PubMed  PubMed Central  Google Scholar 

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Astur, D.C., Cohen, M. (2023). Anterior Cruciate Ligament Injury in Pediatric Population. In: Espregueira-Mendes, J., Karlsson, J., Musahl, V., Ayeni, O.R. (eds) Orthopaedic Sports Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-65430-6_32-1

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  • DOI: https://doi.org/10.1007/978-3-030-65430-6_32-1

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  • Print ISBN: 978-3-030-65430-6

  • Online ISBN: 978-3-030-65430-6

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