Management status of anterior cruciate ligament injury in children and adolescents_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Jiang , LUO Wei , ZHENG Huifeng , REN Fuji , ZHAO Qian ,  HUANG Jingmin

The Second Ward of Sports Injury and Arthroscopy, Tianjin Hospital, Tianjin, 300211, P. R. China;

Corresponding author：

HUANG Jingmin, Email: tjyyhjm@163.com

Keywords：

Children; adolescent; anterior cruciate ligament injury; epiphyseal plate; surgical technique

DOI：

10.7507/1002-1892.202112006

Video：

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Objective To summarize the current management of anterior cruciate ligament (ACL) injury in children and adolescents, in order to provide reference for the management of ACL injury in children and adolescents. Methods The relevant literature at home and abroad in recent years was extensively accessed to summarize the management status of ACL injury in children and adolescent. Results The number of ACL injury in children and adolescents is increasing every year. The diagnosis of ACL mainly depends on symptoms and signs. Rehabilitation, physeal-sparing techniques, partial transphyseal techniques, all-epiphyseal techniques, and transphyseal techniques are used to treat ACL injury in children and adolescents. Conclusion Dynamic monitoring of knee joint in children and adolescents should be strengthened. The best treatment for ACL injury in children and adolescents is selected according to the patients’ actual age, bone age, Tanner stage, and physiological conditions such as menstruation, body growth speed, and other characteristics.

Citation： WU Jiang, LUO Wei, ZHENG Huifeng, REN Fuji, ZHAO Qian, HUANG Jingmin. Management status of anterior cruciate ligament injury in children and adolescents. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(4): 495-499. doi: 10.7507/1002-1892.202112006 Copy

1.	Liu JX, Jazrawi L. Anterior cruciate ligament ruptures in the skeletally immature current state of the art. Bull Hosp Jt Dis (2013), 2020, 78(1): 46-52.
2.	Abruscato K, Browning K, Deleandro D, et al. Diagnostic accuracy of the lever sign in detecting anterior cruciate ligament tears: A systematic review and meta-analysis. Int J Sports Phys Ther, 2019, 14(1): 2-13.
3.	Zhao GL, Lyu JY, Liu CQ, et al. A modified anterior drawer test for anterior cruciate ligament ruptures. J Orthop Surg Res, 2021, 16(1): 260. doi: 10.1186/s13018-021-02381-x.
4.	Kocher MS, DiCanzio J, Zurakowski D, et al. Diagnostic performance of clinical examination and selective magnetic resonance imaging in the evaluation of intraarticular knee disorders in children and adolescents. Am J Sports Med, 2001, 29(3): 292-296.
5.	Logerstedt DS, Scalzitti D, Risberg MA, et al. Knee stability and movement coordination impairments: Knee ligament sprain revision 2017. J Orthop Sports Phys Ther, 2017, 47(11): A1-A47.
6.	Madelaine A, Fournier G, Sappey-Marinier E, et al. Conservative management of anterior cruciate ligament injury in paediatric population: About 53 patients. Orthop Traumatol Surg Res, 2018, 104(8S): S169-S173.
7.	Harris BT, Eichman EA, Johal MJ, et al. Pediatric anterior cruciate ligament reconstruction: A reason not to wait until skeletal maturity. Cureus, 2021, 13(11): e19597. doi: 10.7759/cureus.19597.
8.	Trivedi V, Mishra P, Verma D. Pediatric ACL injuries: A review of current concepts. Open Orthop J, 2017, 11: 378-388.
9.	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.
10.	Ardern CL, Ekås GR, Grindem H, et al. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. Br J Sports Med, 2018, 52(7): 422-438.
11.	Kocher MS, Heyworth BE, Fabricant PD, et al. Outcomes of physeal-sparing ACL reconstruction with iliotibial band autograft in skeletally immature prepubescent children. J Bone Joint Surg (Am), 2018, 100(13): 1087-1094.
12.	Perkins CA, Willimon SC. Pediatric anterior cruciate ligament reconstruction. Orthop Clin North Am, 2020, 51(1): 55-63.
13.	Anderson AF. Transepiphyseal replacement of the anterior cruciate ligament in skeletally immature patients. A preliminary report. J Bone Joint Surg (Am), 2003, 85(7): 1255-1263.
14.	Gupta A, Tejpal T, Shanmugaraj A, et al. 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.
15.	DeFrancesco CJ, Storey EP, Shea KG, et al. Challenges in the management of anterior cruciate ligament ruptures in skeletally immature patients. Instr Course Lect, 2018, 67: 391-402.
16.	Gausden EB, Calcei JG, Fabricant PD, et al. Surgical options for anterior cruciate ligament reconstruction in the young child. Curr Opin Pediatr, 2015, 27(1): 82-91.
17.	Cordasco FA, Mayer SW, Green DW. All-inside, all-epiphyseal anterior cruciate ligament reconstruction in skeletally immature athletes: Return to sport, incidence of second surgery, and 2-year clinical outcomes. Am J Sports Med, 2017, 45(4): 856-863.
18.	Wall EJ, Ghattas PJ, Eismann EA, et al. Outcomes and complications after all-epiphyseal anterior cruciate ligament reconstruction in skeletally immature patients. Orthop J Sports Med, 2017, 5(3): 2325967117693604. doi: 10.1177/2325967117693604.
19.	Roberti di Sarsina T, Macchiarola L, Signorelli C, et al. Anterior cruciate ligament reconstruction with an all-epiphyseal “over-the-top” technique is safe and shows low rate of failure in skeletally immature athletes. Knee Surg Sports Traumatol Arthrosc, 2019, 27(2): 498-506.
20.	Coleman S, Gallo R, Kompel J, et al. A low-profile method of hybrid tibial fixation for soft tissue grafts in anterior cruciate ligament reconstruction. Orthopedics, 2009, 32(4): orthosupersite. com/view. asp?rID=38351. doi: 10.3928/01477447-20090401-01.
21.	Willson RG, Kostyun RO, Milewski MD, et al. Anterior cruciate ligament reconstruction in skeletally immature patients: Early results using a hybrid physeal-sparing technique. Orthop J Sports Med, 2018, 6(2): 2325967118755330. doi: 10.1177/2325967118755330.
22.	Erquicia JI, Ibañez M, Espinoza-Von Bischhoffshausen R, et al. Modification of the hybrid anatomic technique for anterior cruciate ligament reconstruction in pediatric patients. Arthrosc Tech, 2020, 10(1): e37-e42.
23.	Chambers CC, Monroe EJ, Allen CR, et al. Partial transphyseal anterior cruciate ligament reconstruction: Clinical, functional, and radiographic outcomes. Am J Sports Med, 2019, 47(6): 1353-1360.
24.	李阳, 季明亮, 陆军. 骨骺未闭合儿童与青少年前交叉韧带体部损伤的研究进展. 中国骨与关节杂志, 2019, 8(5): 362-367.
25.	陈剑锐, 任龙韬. 少年儿童前交叉韧带损伤诊治进展. 中华小儿外科杂志, 2007, 28(9): 494-497.
26.	Fabricant PD, Kocher MS. Management of ACL injuries in children and adolescents. J Bone Joint Surg (Am), 2017, 99(7): 600-612.
27.	Engelman GH, Carry PM, Hitt KG, et al. Comparison of allograft versus autograft anterior cruciate ligament reconstruction graft survival in an active adolescent cohort. Am J Sports Med, 2014, 42(10): 2311-2318.
28.	Kaeding CC, Aros B, Pedroza A, et al. Allograft versus autograft anterior cruciate ligament reconstruction: Predictors of failure from a MOON prospective longitudinal cohort. Sports Health, 2011, 3(1): 73-81.
29.	Bayer S, Meredith SJ, Wilson KW, et al. Knee morphological risk factors for anterior cruciate ligament injury: A systematic review. J Bone Joint Surg (Am), 2020, 102(8): 703-718.
30.	Yellin JL, Parisien RL, Talathi NS, et al. Narrow Notch width is a risk factor for anterior cruciate ligament injury in the pediatric population: A multicenter study. Arthrosc Sports Med Rehabil, 2021, 3(3): e823-e828.
31.	Edwards TC, Naqvi AZ, Dela Cruz N, et al. Predictors of pediatric anterior cruciate ligament injury: The influence of steep lateral posterior tibial slope and its relationship to the lateral meniscus. Arthroscopy, 2021, 37(5): 1599-1609.
32.	Petushek EJ, Sugimoto D, Stoolmiller M, et al. Evidence-based best-practice guidelines for preventing anterior cruciate ligament injuries in young female athletes: A systematic review and meta-analysis. Am J Sports Med, 2019, 47(7): 1744-1753.
33.	Rössler R, Junge A, Bizzini M, et al. A multinational cluster randomised controlled trial to assess the efficacy of ‘11+kids’: A warm-up programme to prevent injuries in children’s football. Sports Med, 2018, 48(6): 1493-1504.
34.	Rössler R, Donath L, Bizzini M, et al. A new injury prevention programme for children’s football-FIFA 11+kids-can improve motor performance: a cluster-randomised controlled trial. J Sports Sci, 2016, 34(6): 549-556.

1. Liu JX, Jazrawi L. Anterior cruciate ligament ruptures in the skeletally immature current state of the art. Bull Hosp Jt Dis (2013), 2020, 78(1): 46-52.
2. Abruscato K, Browning K, Deleandro D, et al. Diagnostic accuracy of the lever sign in detecting anterior cruciate ligament tears: A systematic review and meta-analysis. Int J Sports Phys Ther, 2019, 14(1): 2-13.
3. Zhao GL, Lyu JY, Liu CQ, et al. A modified anterior drawer test for anterior cruciate ligament ruptures. J Orthop Surg Res, 2021, 16(1): 260. doi: 10.1186/s13018-021-02381-x.
4. Kocher MS, DiCanzio J, Zurakowski D, et al. Diagnostic performance of clinical examination and selective magnetic resonance imaging in the evaluation of intraarticular knee disorders in children and adolescents. Am J Sports Med, 2001, 29(3): 292-296.
5. Logerstedt DS, Scalzitti D, Risberg MA, et al. Knee stability and movement coordination impairments: Knee ligament sprain revision 2017. J Orthop Sports Phys Ther, 2017, 47(11): A1-A47.
6. Madelaine A, Fournier G, Sappey-Marinier E, et al. Conservative management of anterior cruciate ligament injury in paediatric population: About 53 patients. Orthop Traumatol Surg Res, 2018, 104(8S): S169-S173.
7. Harris BT, Eichman EA, Johal MJ, et al. Pediatric anterior cruciate ligament reconstruction: A reason not to wait until skeletal maturity. Cureus, 2021, 13(11): e19597. doi: 10.7759/cureus.19597.
8. Trivedi V, Mishra P, Verma D. Pediatric ACL injuries: A review of current concepts. Open Orthop J, 2017, 11: 378-388.
9. 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.
10. Ardern CL, Ekås GR, Grindem H, et al. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. Br J Sports Med, 2018, 52(7): 422-438.
11. Kocher MS, Heyworth BE, Fabricant PD, et al. Outcomes of physeal-sparing ACL reconstruction with iliotibial band autograft in skeletally immature prepubescent children. J Bone Joint Surg (Am), 2018, 100(13): 1087-1094.
12. Perkins CA, Willimon SC. Pediatric anterior cruciate ligament reconstruction. Orthop Clin North Am, 2020, 51(1): 55-63.
13. Anderson AF. Transepiphyseal replacement of the anterior cruciate ligament in skeletally immature patients. A preliminary report. J Bone Joint Surg (Am), 2003, 85(7): 1255-1263.
14. Gupta A, Tejpal T, Shanmugaraj A, et al. 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.
15. DeFrancesco CJ, Storey EP, Shea KG, et al. Challenges in the management of anterior cruciate ligament ruptures in skeletally immature patients. Instr Course Lect, 2018, 67: 391-402.
16. Gausden EB, Calcei JG, Fabricant PD, et al. Surgical options for anterior cruciate ligament reconstruction in the young child. Curr Opin Pediatr, 2015, 27(1): 82-91.
17. Cordasco FA, Mayer SW, Green DW. All-inside, all-epiphyseal anterior cruciate ligament reconstruction in skeletally immature athletes: Return to sport, incidence of second surgery, and 2-year clinical outcomes. Am J Sports Med, 2017, 45(4): 856-863.
18. Wall EJ, Ghattas PJ, Eismann EA, et al. Outcomes and complications after all-epiphyseal anterior cruciate ligament reconstruction in skeletally immature patients. Orthop J Sports Med, 2017, 5(3): 2325967117693604. doi: 10.1177/2325967117693604.
19. Roberti di Sarsina T, Macchiarola L, Signorelli C, et al. Anterior cruciate ligament reconstruction with an all-epiphyseal “over-the-top” technique is safe and shows low rate of failure in skeletally immature athletes. Knee Surg Sports Traumatol Arthrosc, 2019, 27(2): 498-506.
20. Coleman S, Gallo R, Kompel J, et al. A low-profile method of hybrid tibial fixation for soft tissue grafts in anterior cruciate ligament reconstruction. Orthopedics, 2009, 32(4): orthosupersite. com/view. asp?rID=38351. doi: 10.3928/01477447-20090401-01.
21. Willson RG, Kostyun RO, Milewski MD, et al. Anterior cruciate ligament reconstruction in skeletally immature patients: Early results using a hybrid physeal-sparing technique. Orthop J Sports Med, 2018, 6(2): 2325967118755330. doi: 10.1177/2325967118755330.
22. Erquicia JI, Ibañez M, Espinoza-Von Bischhoffshausen R, et al. Modification of the hybrid anatomic technique for anterior cruciate ligament reconstruction in pediatric patients. Arthrosc Tech, 2020, 10(1): e37-e42.
23. Chambers CC, Monroe EJ, Allen CR, et al. Partial transphyseal anterior cruciate ligament reconstruction: Clinical, functional, and radiographic outcomes. Am J Sports Med, 2019, 47(6): 1353-1360.
24. 李阳, 季明亮, 陆军. 骨骺未闭合儿童与青少年前交叉韧带体部损伤的研究进展. 中国骨与关节杂志, 2019, 8(5): 362-367.
25. 陈剑锐, 任龙韬. 少年儿童前交叉韧带损伤诊治进展. 中华小儿外科杂志, 2007, 28(9): 494-497.
26. Fabricant PD, Kocher MS. Management of ACL injuries in children and adolescents. J Bone Joint Surg (Am), 2017, 99(7): 600-612.
27. Engelman GH, Carry PM, Hitt KG, et al. Comparison of allograft versus autograft anterior cruciate ligament reconstruction graft survival in an active adolescent cohort. Am J Sports Med, 2014, 42(10): 2311-2318.
28. Kaeding CC, Aros B, Pedroza A, et al. Allograft versus autograft anterior cruciate ligament reconstruction: Predictors of failure from a MOON prospective longitudinal cohort. Sports Health, 2011, 3(1): 73-81.
29. Bayer S, Meredith SJ, Wilson KW, et al. Knee morphological risk factors for anterior cruciate ligament injury: A systematic review. J Bone Joint Surg (Am), 2020, 102(8): 703-718.
30. Yellin JL, Parisien RL, Talathi NS, et al. Narrow Notch width is a risk factor for anterior cruciate ligament injury in the pediatric population: A multicenter study. Arthrosc Sports Med Rehabil, 2021, 3(3): e823-e828.
31. Edwards TC, Naqvi AZ, Dela Cruz N, et al. Predictors of pediatric anterior cruciate ligament injury: The influence of steep lateral posterior tibial slope and its relationship to the lateral meniscus. Arthroscopy, 2021, 37(5): 1599-1609.
32. Petushek EJ, Sugimoto D, Stoolmiller M, et al. Evidence-based best-practice guidelines for preventing anterior cruciate ligament injuries in young female athletes: A systematic review and meta-analysis. Am J Sports Med, 2019, 47(7): 1744-1753.
33. Rössler R, Junge A, Bizzini M, et al. A multinational cluster randomised controlled trial to assess the efficacy of ‘11+kids’: A warm-up programme to prevent injuries in children’s football. Sports Med, 2018, 48(6): 1493-1504.
34. Rössler R, Donath L, Bizzini M, et al. A new injury prevention programme for children’s football-FIFA 11+kids-can improve motor performance: a cluster-randomised controlled trial. J Sports Sci, 2016, 34(6): 549-556.

Chinese Journal of Reparative and Reconstructive Surgery

Management status of anterior cruciate ligament injury in children and adolescents

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