Current Treatment Update for Anterior Cruciate Ligament Tears in Adolescence: A Narrative Review
Abstract
To follow up regarding orthopedic updates in respect of the treatment of ACL tears in adolescence. The methods we performed a comprehensive literature search from four databases to synthesize a narrative review of available evidence on the recent update of ACL treatment in adolescence. The results is conservative treatment remains preferred for partial ACL tears in adolescence. Some surgeons have favored non-operative or delayed surgical treatment until skeletal maturity has reached or after a failed trial of non-operative management. However, adolescent patients who delayed ACLR for more than 12 weeks had increased risk of meniscal pathology and irreparable meniscal tears by a 4.3 and 3.2 times, respectively. Various ACL reconstruction techniques for adolescents have developed to respect growing physes, these are physeal sparing (extraphyseal and all-epiphyseal), partial transphyseal, and transphyseal. The conclusions is early operative treatment of ACL injury is preferred compared to non-operative or delayed treatment. The reconstruction techniques were adjusted to each patient's potential for growth, the facilities' capabilities, and the surgeons' skills. High-growth potential patients should still undergo surgery using a technique with the slightest manipulation of growth cartilage.
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Deviandri R, van der Veen HC, Lubis AMT, Utoyo GA, van den Akker-Scheek I, Postma MJ. Burden and Cost of Anterior Cruciate Ligament Reconstruction and Reimbursement of Its Treatment in a Developing Country: An Observational Study in Indonesia. Clinicoecon Outcomes Res. 2022;14:479-486. doi:10.2147/CEOR.S368840
Tepolt FA, Feldman L, Kocher MS. Trends in Pediatric ACL Reconstruction From the PHIS Database. Journal of Pediatric Orthopaedics. 2018;38(9):e490-e494. doi:10.1097/BPO.0000000000001222
Adolescent health. Accessed October 5, 2022. https://www.who.int/health-topics/adolescent-health
Longo UG, Salvatore G, Ruzzini L, et al. Trends of anterior cruciate ligament reconstruction in children and young adolescents in Italy show a constant increase in the last 15 years. Knee Surg Sports Traumatol Arthrosc. 2021;29(6):1728-1733. doi:10.1007/s00167-020-06203-1
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(3):675-680. doi:10.1177/0363546513518412
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):1962-1972. doi:10.1177/0363546520959619
James EW, Dawkins BJ, Schachne JM, et al. Early Operative Versus Delayed Operative Versus Nonoperative Treatment of Pediatric and Adolescent Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis. Am J Sports Med. 2021;49(14):4008-4017. doi:10.1177/0363546521990817
Blom A, Warwick D, Whitehouse MR, eds. Apley & Slomon’s System of Othropaedics and Trauma. 10th ed. CRC Press; 2018.
Kopkow C, Lange T, Hoyer A, Lützner J, Schmitt J. Physical tests for diagnosing anterior cruciate ligament rupture. Cochrane Database Syst Rev. 2018;2018(12):CD011925. doi:10.1002/14651858.CD011925.pub2
Tanaka S, Inoue Y, Masuda Y, Tian H, Jung H, Tanaka R. Diagnostic Accuracy of Physical Examination Tests for Suspected Acute Anterior Cruciate Ligament Injury: A Systematic Review and Meta-Analysis. Int J Sports Phys Ther. 2022;17(5):742-752. doi:10.26603/001c.36434
Sokal PA, Norris R, Maddox TW, Oldershaw RA. The diagnostic accuracy of clinical tests for anterior cruciate ligament tears are comparable but the Lachman test has been previously overestimated: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022;30(10):3287-3303. doi:10.1007/s00167-022-06898-4
Kay J, Memon M, Shah A, et al. Earlier anterior cruciate ligament reconstruction is associated with a decreased risk of medial meniscal and articular cartilage damage in children and adolescents: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2018;26(12):3738-3753. doi:10.1007/s00167-018-5012-5
Ahn JH, Bae TS, Kang KS, Kang SY, Lee SH. Longitudinal tear of the medial meniscus posterior horn in the anterior cruciate ligament-deficient knee significantly influences anterior stability. Am J Sports Med. 2011;39(10):2187-2193. doi:10.1177/0363546511416597
Kay J, Memon M, Marx RG, Peterson D, Simunovic N, Ayeni OR. Over 90 % of children and adolescents return to sport after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2018;26(4):1019-1036. doi:10.1007/s00167-018-4830-9
Kocher M. Pediatric ACL: Understanding Treatment Options (PLUTO). clinicaltrials.gov; 2022. Accessed November 22, 2022. https://clinicaltrials.gov/ct2/show/NCT02772770
A Comprehensive Review of Partial Anterior Cruciate Ligament... : JBJS. Accessed November 26, 2022. https://journals.lww.com/jbjsjournal/Abstract/2009/01000/A_Comprehensive_Review_of_Partial_Anterior.25.aspx
McClincy MP, Heyworth BE. Partial ACL Injuries in Pediatric and Adolescent Athletes. In: Parikh SN, ed. The Pediatric Anterior Cruciate Ligament: Evaluation and Management Strategies. Springer International Publishing; 2018:83-95. doi:10.1007/978-3-319-64771-5_9
Kocher MS, Micheli LJ, Zurakowski D, Luke A. Partial tears of the anterior cruciate ligament in children and adolescents. Am J Sports Med. 2002;30(5):697-703. doi:10.1177/03635465020300051201
Saueressig T, Braun T, Steglich N, et al. Primary surgery versus primary rehabilitation for treating anterior cruciate ligament injuries: a living systematic review and meta-analysis. Br J Sports Med. 2022;56(21):1241-1251. doi:10.1136/bjsports-2021-105359
Madelaine A, Fournier G, Sappey-Marinier E, et al. Conservative management of anterior cruciate ligament injury in paediatric population: About 53 patients. Orthopaedics & Traumatology: Surgery & Research. 2018;104(8, Supplement):S169-S173. doi:10.1016/j.otsr.2018.09.001
Lucena T, Cavaignac M, Marot V, et al. Iliotibial band autograft is a suitable alternative graft for anterior cruciate ligament reconstruction: a systematic review and meta-analysis of outcomes. Knee Surg Sports Traumatol Arthrosc. 2022;30(5):1679-1690. doi:10.1007/s00167-021-06701-w
Pagliazzi G, Cuzzolin M, Pacchiarini L, Delcogliano M, Filardo G, Candrian C. Physeal-sparing ACL reconstruction provides better knee laxity restoration but similar clinical outcomes to partial transphyseal and complete transphyseal approaches in the pediatric population: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. Published online July 15, 2022. doi:10.1007/s00167-022-07032-0
Knapik DM, Voos JE. Anterior Cruciate Ligament Injuries in Skeletally Immature Patients: A Meta-analysis Comparing Repair Versus Reconstruction Techniques. Journal of Pediatric Orthopaedics. 2020;40(9):492. doi:10.1097/BPO.0000000000001569
Gupta A, Tejpal T, Shanmugaraj A, Horner NS, Gohal C, Khan M. All-epiphyseal anterior cruciate ligament reconstruction produces good functional outcomes and low complication rates in pediatric patients: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2020;28(8):2444-2452. doi:10.1007/s00167-020-06085-3
Chambers CC, Monroe EJ, Allen CR, Pandya NK. Partial Transphyseal Anterior Cruciate Ligament Reconstruction: Clinical, Functional, and Radiographic Outcomes. Am J Sports Med. 2019;47(6):1353-1360. doi:10.1177/0363546519836423
Ghosh K, Salmon LJ, Heath E, Pinczewski LA, Roe JP. Transphyseal anterior cruciate ligament reconstruction using living parental donor hamstring graft: excellent clinical results at 2 years in a cohort of 100 patients. Knee Surg Sports Traumatol Arthrosc. 2020;28(8):2511-2518. doi:10.1007/s00167-019-05842-3
Petersen W, Bierke S, Stöhr A, Stoffels T, Häner M. A systematic review of transphyseal ACL reconstruction in children and adolescents: comparing the transtibial and independent femoral tunnel drilling techniques. Journal of Experimental Orthopaedics. 2023;10(1):7. doi:10.1186/s40634-023-00577-0
Pennock AT, Johnson KP, Turk RD, et al. Transphyseal Anterior Cruciate Ligament Reconstruction in the Skeletally Immature: Quadriceps Tendon Autograft Versus Hamstring Tendon Autograft. Orthop J Sports Med. 2019;7(9):2325967119872450. doi:10.1177/2325967119872450
Bayomy AF, Bompadre V, Schmale GA. The Impact of Transphyseal Anterior Cruciate Ligament Reconstruction on Lower Extremity Growth and Alignment. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019;35(3):940-949. doi:10.1016/j.arthro.2018.10.132
Fabricant PD, Kocher MS. Management of ACL Injuries in Children and Adolescents. J Bone Joint Surg Am. 2017;99(7):600-612. doi:10.2106/JBJS.16.00953
Perkins CA, Willimon SC. Pediatric Anterior Cruciate Ligament Reconstruction. Orthop Clin North Am. 2020;51(1):55-63. doi:10.1016/j.ocl.2019.08.009
Micheli LJ, Rask B, Gerberg L. Anterior cruciate ligament reconstruction in patients who are prepubescent. Clin Orthop Relat Res. 1999;(364):40-47. doi:10.1097/00003086-199907000-00006
Kocher MS, Garg S, Micheli LJ. Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescents. J Bone Joint Surg Am. 2005;87(11):2371-2379. doi:10.2106/JBJS.D.02802
Sugimoto D, Whited AJ, Brodeur JJ, et al. Long-Term Follow-up of Skeletally Immature Patients With Physeal-Sparing Combined Extra-/Intra-articular Iliotibial Band Anterior Cruciate Ligament Reconstruction: A 3-Dimensional Motion Analysis. Am J Sports Med. 2020;48(8):1900-1906. doi:10.1177/0363546520927399
Anderson AF. Transepiphyseal replacement of the anterior cruciate ligament using quadruple hamstring grafts in skeletally immature patients. J Bone Joint Surg Am. 2004;86-A Suppl 1(Pt 2):201-209. doi:10.2106/00004623-200409001-00010
Lawrence JTR, Bowers AL, Belding J, Cody SR, Ganley TJ. All-epiphyseal anterior cruciate ligament reconstruction in skeletally immature patients. Clin Orthop Relat Res. 2010;468(7):1971-1977. doi:10.1007/s11999-010-1255-2
McCarthy MM, Graziano J, Green DW, Cordasco FA. All-epiphyseal, all-inside anterior cruciate ligament reconstruction technique for skeletally immature patients. Arthrosc Tech. 2012;1(2):e231-239. doi:10.1016/j.eats.2012.08.005
Lipscomb AB, Anderson AF. Tears of the anterior cruciate ligament in adolescents. J Bone Joint Surg Am. 1986;68(1):19-28.
Jeon JY, Lee J, Kang MS. Transphyseal anterior cruciate ligament reconstruction in adolescents with substantial remaining growth causes temporary growth arrest resulting in subclinical leg-length discrepancy. Medicine (Baltimore). 2019;98(26):e16081. doi:10.1097/MD.0000000000016081
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(4):989-1010. doi:10.1007/s00167-018-4865-y
Petersen W, Zantop T. Anatomy of the anterior cruciate ligament with regard to its two bundles. Clin Orthop Relat Res. 2007;454:35-47. doi:10.1097/BLO.0b013e31802b4a59
Zantop T, Wellmann M, Fu FH, Petersen W. Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med. 2008;36(1):65-72. doi:10.1177/0363546507308361
van Eck CF, Gravare-Silbernagel K, Samuelsson K, et al. Evidence to support the interpretation and use of the Anatomic Anterior Cruciate Ligament Reconstruction Checklist. J Bone Joint Surg Am. 2013;95(20):e153. doi:10.2106/JBJS.L.01437
DOI: https://doi.org/10.46355/hipknee.v5i2.158
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