Abstract
PurposeThe aim of this study was to assess midterm clinical outcomes in Tanner 1–2 patients with proximal anterior cruciate ligament (ACL) tears following arthroscopic-surgical repair using an absorbable or an all-suture anchor.MethodsFourteen (9.2 ± 2.9 years-old) of 19 skeletally immature patients reached the 2 years of clinical follow-up. Physical examinations included the Lachman test, Pivot-shift test, One-leg Hop test, Pedi-IKDC as well as Lysholm and Tegner activity scores; knee stability was measured with a KT-1000 arthrometer. Overall re-rupture rates were also evaluated in all operated patients.ResultsAt 2 years post-surgery, the Lysholm score was 93.6 ± 4.3 points, and the Pedi-IKDC score was 95.7 ± 0.1. All patients returned to the same sport activity level as prior to ACL lesion within 8.5 ± 2.9 months, with one exception who reported a one-point reduction in their Tegner Activity score. No leg-length discrepancies or malalignments were observed. Four patients presented grade 1 Lachman scores, and of these, three presented grade 1 (glide) score at Pivot-shift; clinical stability tests were negative for all other patients. Anterior tibial shift showed a mean side-to-side difference of 2.2 mm (range 1–3 mm). The One-leg Hop test showed lower limb symmetry (99.9% ± 9.5) with the contralateral side. Overall, 4 out of 19 patients presented a re-rupture of the ACL with a median time between surgery and re-rupture of 3.9 years (range 1–7).ConclusionThis surgical technique efficiently repairs proximal ACL tears, leading to a restoration of knee stability and a quick return to an active lifestyle, avoiding growth plate disruption.Level of evidenceIV.
Highlights
Participation of paediatric and adolescent children in highenergy sports and associated intensive physical training programs has increased dramatically in recent years
Informed and written consent was collected from every patient; assent of both parents was confirmed in writing in agreement with our protocol previously approved by the local ethics committee and conforming to the principles outlined in the World Medical Association Declaration of Helsinki
For the first objective of the study, five of them did not meet the inclusion criteria, while one patient was lost to follow-up
Summary
Participation of paediatric and adolescent children in highenergy sports and associated intensive physical training programs has increased dramatically in recent years. The increased incidence of sports-related injuries, in particular anterior cruciate ligament (ACL) injuries, has increased the need for surgical treatment of these skeletally immature patients [2, 29, 47]. The treatment of choice for these injuries was conservative; recent studies have shown that delayed surgery is correlated with an increased risk of joint instability, medial meniscal tear, and significantly longer time to return to sporting activities [17, 19, 31]. It is well known that skeletal immaturity predisposes patients to risks of growth disturbances. To select the optimal treatment procedure, a preoperative measurement of skeletal age and Tanner staging, as well as a standing full-length lower limb radiograph is required to highlight any length discrepancies and malalignments [1]
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