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Review
. 2024 Jul;17(7):258-272.
doi: 10.1007/s12178-024-09897-9. Epub 2024 Apr 19.

Management of Anterior Cruciate Ligament Tears in Skeletally Immature Patients

Elise C Bixby  1 , Benton E Heyworth  2
Affiliations
Review

Management of Anterior Cruciate Ligament Tears in Skeletally Immature Patients

Elise C Bixby et al. Curr Rev Musculoskelet Med. 2024 Jul.

Abstract

Purpose of review: Anterior cruciate ligament (ALC) tears are increasingly common in skeletally immature patients, as more children and adolescents participate in intensive sports training and specialization at increasingly younger ages. These injuries were historically treated nonoperatively, given concerns for physeal damage and subsequent growth disturbances after traditional ACL reconstruction techniques. However, there is now sufficient data to suggest superior outcomes with operative treatment, specifically with physeal-sparing and physeal-respecting techniques. This article reviews considerations of skeletal maturity in patients with ACL tears, then discusses surgical techniques, with a focus on their unique indications and outcomes. Additional surgical adjuncts and components of postoperative rehabilitation, which may reduce retear rates, are also considered.

Recent findings: Current research shows favorable patient-reported outcomes and high return-to-sport rates after ACL reconstruction in skeletally immature patients. Graft rupture (ACL retear) rates are low, but notably higher than in most adult populations. Historically, there has been insufficient research to comprehensively compare reconstruction techniques used in this patient population. However, thoughtful systematic reviews and multicenter prospective studies are emerging to address this deficit. Also, more recent data suggests the addition of lateral extra-articular procedures and stringent return-to-sports testing may lower retear rates. Physeal-sparing and physeal-respecting ACL reconstructions result in stabilization of the knee, while respecting the growth remaining in children or skeletally immature adolescents. Future research will be essential to compare these techniques, given that more than one may be appropriate for patients of a specific age and skeletal maturity.

Keywords: Adolescent; Anterior cruciate ligament; Growth disturbance; Pediatric; Skeletally immature.

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Conflict of interest statement

Benton E. Heyworth, MD has textbook related royalties or licenses from Springer Science & Business Media. He has also received consulting fees from Kairos Surgical, Arthrex Inc., and Imagen Technologies. He also holds stock in Imagen Technologies. He was previously a Board of Directors Member of the Pediatric Research in Sports Medicine Society and a previous committee member and/or chair for the Pediatric Orthopaedic Society of North America. Elise C. Bixby, MD has received grant funding from Arthrex as well as educational support from Smith + Nephew Inc. and Peerless Surgical Inc. She is a member of the Patellofemoral Instability Research Interest Group.

Figures

Fig. 1
Fig. 1
Physeal sparing techniques include (A) over the top reconstructions with iliotibial band and (B) all-epiphyseal reconstructions. Physeal respecting techniques include (C) partial transphyseal (hybrid) reconstructions and some (D) transphyseal reconstructions
See this image and copyright information in PMC

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References

    1. Dodwell ER, Lamont LE, Green DW, Pan TJ, Marx RG, Lyman S. 20 years of pediatric anterior cruciate ligament reconstruction in New York State. Am J Sports Med. 2014;42:675–680. doi: 10.1177/0363546513518412. - DOI - PubMed
    1. Shaw L, Finch CF. Trends in pediatric and adolescent anterior cruciate ligament injuries in Victoria, Australia 2005–2015. Int J Environ Res Public Health. 2017;14:599. doi: 10.3390/ijerph14060599. - DOI - PMC - PubMed
    1. Kooy CEVW, Jakobsen RB, Fenstad AM, Persson A, Visnes H, Engebretsen L, et al. Major increase in incidence of pediatric ACL reconstructions from 2005 to 2021: a study from the Norwegian Knee Ligament Register. Am J Sports Med. 2005;2023:3635465231185742. - PMC - PubMed
    1. 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;49:1962–1972. doi: 10.1177/0363546520959619. - DOI - PubMed
    1. Werner BC, Yang S, Looney AM, Gwathmey FWJ. Trends in pediatric and adolescent anterior cruciate ligament injury and reconstruction. J Pediatr Orthop. 2016;36:447–452. doi: 10.1097/BPO.0000000000000482. - DOI - PubMed