Pediatric
There is limited evidence in skeletally immature patients with torn ACLs, but it supports that the practitioner might perform surgical reconstruction because it reduces activity related disability and recurrent instability which may lead to additional injury.
LIMITED RECOMMENDATION Rationale
There was one low and two very low strength studies comparing surgical reconstruction to non-operative treatment. 72, 88, 110 Surgical reconstruction demonstrated a significant advantage over non-operative treatment in objective knee stability (KT1000, pivot shift, Lachman), subjective knee function scores (IKDC, Zarins and Rowe score, Lysholm), and Tegner activity score. None of three studies reported a clinically significant valgus deformity or limb length discrepancy.
Benefits of Implementation
Potential benefits of implementing this recommendation include: improving knee stability and functional outcomes in skeletally immature patients with ACL injury.
Possible Harms of Implementation
Potential harms include: physeal injury, graft failure and surgical complications.
Future Research
Prospective studies on transphyseal versus all-epiphyseal reconstruction, intra-articular versus extra-articular techniques, and long-term outcomes of young patients following ACL reconstruction. Prospective comparative studies of non-operative treatment and ACL reconstruction in skeletally immature patients are necessary.
Benefits of Implementation
Potential benefits of implementing this recommendation include: improving knee stability and functional outcomes in skeletally immature patients with ACL injury.
Possible Harms of Implementation
Potential harms include: physeal injury, graft failure and surgical complications.
Future Research
Prospective studies on transphyseal versus all-epiphyseal reconstruction, intra-articular versus extra-articular techniques, and long-term outcomes of young patients following ACL reconstruction. Prospective comparative studies of non-operative treatment and ACL reconstruction in skeletally immature patients are necessary.
- (110) Streich NA, Barie A, Gotterbarm T, Keil M, Schmitt H. Transphyseal reconstruction of the anterior cruciate ligament in prepubescent athletes. Knee Surg Sports Traumatol Arthrosc 2010;18:1481-1486.
- (72) Moksnes H, Engebretsen L, Eitzen I, Risberg MA. Functional outcomes following a non-operative treatment algorithm for anterior cruciate ligament injuries in skeletally immature children 12 years and younger. A prospective cohort with 2 years follow-up. Br J Sports Med 2013;47:488-494.
- (88) Pressman AE, Letts RM, Jarvis JG. Anterior cruciate ligament tears in children: an analysis of operative versus nonoperative treatment. J Pediatr Orthop 1997;17:505-511.