Current Treatment Update for Anterior Cruciate Ligament Tears in Adolescence: A Narrative Review
Keywords
anterior cruciate ligament reconstruction
adolescent
early or delayed
physeal sparing
transphyseal
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.
References
- 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