Advertisement

LO SCALPELLO-OTODI Educational

, Volume 32, Issue 3, pp 317–321 | Cite as

Le lesioni del legamento crociato anteriore del ginocchio del paziente in accrescimento

  • Antonio MemeoEmail author
  • Leopoldo Pedretti
  • Dario D’Amato
  • Paolo Trezza
Aggiornamenti
  • 45 Downloads

ACL lesions in skeletally immature patients

Abstract

ACL injuries in prepubescent patients are being seen with increasing frequency. The reasons include intensive year round training regimens and early sport specialisation, but also a more precise diagnosis of the trauma and its causes. The traditional treatment was conservative, but with poor outcomes and an high rate of chondral and articular damages caused by prolonged instability. As a result, there is the need for surgical anterior cruciate reconstruction even in skeletally immature patients. Many surgical techniques have been described to achieve a physeal sparing reconstruction, thus avoiding iatrogenic damages of the limb growth. The proposed techniques can be divide into three groups: extra-epiphyseal, trans-epiphyseal and all-epiphyseal. Some issues are related to the non-anatomical stabilisation achieved with the extra-epiphyseal reconstruction. All-epiphyseal reconstruction, which involves some technical complexities, should be preferred in younger patients with fully open physes. The trans-epiphyseal approach has shown satisfactory outcomes in patients with older skeletal age, reducing the surgical impact on growth cartilages with some technical adjustments if compared with the usual technique for adults.

Notes

Conflitto di interesse

Gli autori Antonio Memeo, Leopoldo Pedretti, Dario D’Amato e Paolo Trezza dichiarano di non avere alcun conflitto di interesse.

Consenso informato e conformità agli standard etici

Tutte le procedure descritte nello studio e che hanno coinvolto esseri umani sono state attuate in conformità alle norme etiche stabilite dalla dichiarazione di Helsinki del 1975 e successive modifiche. Il consenso informato è stato ottenuto da tutti i pazienti inclusi nello studio.

Human and Animal Rights

Per questo tipo di studio non è richiesto l’inserimento di alcuna dichiarazione relativa agli studi effettuati su esseri umani e animali.

Bibliografia

  1. 1.
    Aichroth PM, Patel DV, Zorrilla P (2002) The natural history and treatment of rupture of the anterior cruciate ligament in children and adolescents. A prospective review. Bone Jt Surg, Br 84:38–42 CrossRefGoogle Scholar
  2. 2.
    Guzzanti V (2003) The natural history and treatment of rupture of the anterior cruciate ligament in children and adolescents. J Bone Jt Surg, Br 85:618–619 CrossRefGoogle Scholar
  3. 3.
    Tsiaviry P, Rabemazava AZ, Ruzic JC et al. (2010) Avulsion fracture of the posterior cruciate ligament in a child: surgical treatment. A case report. Arch Pediatr 17(4):387–390 CrossRefGoogle Scholar
  4. 4.
    Al-Ahaideb A (2013) Posterior cruciate ligament avulsion fracture in children: a case report with long-term follow-up and comprehensive literature review. Eur J Orthop Surg Traumatol 23(Suppl 2):S257–260 CrossRefGoogle Scholar
  5. 5.
    Dodwell ER, Lamont LE, Green DW et al. (2014) 20 years of pediatrics anterior cruciate ligament reconstruction in New York State. Am J Sports Med 40(9):2128–2133 Google Scholar
  6. 6.
    Granan LP, Forssblad M, Lind M, Engebretsen L (2009) The Scandinavian ACL registries: based epidemiology. Acta Orthop 80(5):563–567 CrossRefGoogle Scholar
  7. 7.
    LaBella CR, Hennrikus W, Hewett TE (2014) Anterior cruciate ligament injuries: diagnosis, treatment, and prevention. Pediatrics 133:e1437–e1450 CrossRefGoogle Scholar
  8. 8.
    Eiskjaer S, Larsen ST, Schmidt MB (1988) The significance of hemarthrosis of the knee in children. Arch Orthop Trauma Surg 107:96–98 CrossRefGoogle Scholar
  9. 9.
    VahasarjaV K, Serlo W (1993) Arthroscopy of the acute traumatic knee in children. Prospective study if 138 cases. Acta Orthop Scand 64:580–582 CrossRefGoogle Scholar
  10. 10.
    Shea KG, Pfeiffer R, Wang JH et al. (2004) Anterior cruciate ligament injury in pediatric and adolescent soccer players: an analysis of insurance data. J Pediatr Orthop 24:623–628 CrossRefGoogle Scholar
  11. 11.
    Henry J, Chotel F, Chouteau J et al. (2009) Rupture of the anterior cruciate ligament in children: early reconstruction with open physes or delayed reconstruction to skeletal maturity?. Knee Surg Sports Traumatol Arthorosc 17:748–755 CrossRefGoogle Scholar
  12. 12.
    Memeo A, Pedretti L, Miola F, Albisetti W (2012) Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft in Tanner 3 stage patients with open physes. J Pediatr Orthop B 21(5):415–420 CrossRefGoogle Scholar
  13. 13.
    Anderson AF, Anderson CN (2015) Correlation of meniscal and articular cartilage injuries in children and adolescent with timing of anterior cruciate ligament reconstruction. Am J Sports Med 43(2):275–281 CrossRefGoogle Scholar
  14. 14.
    Lawrence JT, Bowers AL, Belding J et al. (2010) All-epiphyseal anterior cruciate ligament reconstruction in skeletally immature patients. Clin Orthop Relat Res 468:1971–1977 CrossRefGoogle Scholar
  15. 15.
    McCarrol JR, Rettig AC, Shelbourne KD (1988) Anterior cruciate ligament injuries in the young athlete with open physes. Am J Sports Med 16(1):44–47 CrossRefGoogle Scholar
  16. 16.
    Andrews M, Noyes FR, Barber-Westin SD (1994) Anterior cruciate ligament allograft reconstruction in skeletally immature athletes. Am J Sports Med 22:48–54 CrossRefGoogle Scholar
  17. 17.
    Lawrence JT, Argawal N, Ganley TJ (2011) Degeneration of the knee joint in skeletally immature patients with a diagnosis of an anterior cruciate ligament tear: is there harm in delaying the treatment? Am J Sports Med 39:2582–2587 CrossRefGoogle Scholar
  18. 18.
    Vavken P, Murray MM (2011) Treating anterior cruciate ligament tears in skeletally immature patients. Arthroscopy 27:704–716 CrossRefGoogle Scholar
  19. 19.
    Kercher J, Xerogeanes J, Tnnenbaum A et al. (2009) Anterior cruciate ligament reconstruction in the skeletally immature: an anatomical study utilizing 3-dimensional magnetic reconstructions. J Pediatr Orthop 29(2):124–129 CrossRefGoogle Scholar
  20. 20.
    Graf BK, Lange RH, Fujisaki CK et al. (1992) Anterior cruciate ligament tears in skeletally immature patients: meniscal pathology at presentation and after attempted conservative treatment. Arthroscopy 8:229–231 CrossRefGoogle Scholar
  21. 21.
    Anderson AF (2011) Transepiphyseal replacement of the anterior cruciate ligament in skeletally immature patients. A preliminary report. J Bone Jt Surg, Am 85:1255–1263 CrossRefGoogle Scholar
  22. 22.
    Paletta GA Jr (2011) Complete transepiphyseal reconstruction of the anterior cruciate ligament in skeletally immature. Clin Sports Med 30:779–788 CrossRefGoogle Scholar
  23. 23.
    Kennedy A, Coughlin DG, Metzger MF (2011) Biomechanical evaluation of pediatric anterior cruciate ligament reconstruction techniques. Am J Sports Med 39(5):964–971 CrossRefGoogle Scholar
  24. 24.
    Micheli LJ, Rask B, Gerberg L (1999) Anterior cruciate ligament reconstruction in patients who are prepubescent. Clin Orthop Relat Res 364:40–47 CrossRefGoogle Scholar
  25. 25.
    Sena M, Chen J, Dellamaggioria R et al. (2013) Dynamic evaluation of pivot shift kinematics in physeal sparing pediatric anterior cruciate ligament reconstruction techniques. Am J Sports Med 41(4):826–834 CrossRefGoogle Scholar
  26. 26.
    McCarthy M, Graziano J, Green DW, Cordasco F (2012) All-epiphyseal all inside anterior cruciate ligament reconstruction technique for skeletally immature patients. Arthr Tech 1(2):231–239 CrossRefGoogle Scholar
  27. 27.
    Cohen M, Ferretti M, Quarteiro M et al. (2009) Trasepiphyseal anterior cruciate ligament reconstruction in patients with open physes. Arthroscopy 25:831–838 CrossRefGoogle Scholar
  28. 28.
    Kocher MS, Smith JT, Zoric BJ et al. (2007) Transepiphyseal anterior cruciate ligament in skeletally immature pubescent adolescents. J Bone Jt Surg, Am 89:2632–2639 CrossRefGoogle Scholar
  29. 29.
    Shea KG, Apel PJ, Pfeiffer RP, Traughber PD (2007) Anatomy of the proximal tibia in pediatric and adolescent patients: implication for ACL reconstruction and prevention of physeal arrest. Knee Surg Sports Traumatol Arthrosc 15:320–327 CrossRefGoogle Scholar
  30. 30.
    Cruz AI Jr, Fabricant PD, McGraw M et al. (2015) All-epiphyseal ACL reconstruction in children: review of safety and early complications. J Pediatr Orthop 00:1–6 Google Scholar

Copyright information

© Società Italiana Ortopedici Traumatologi Ospedalieri d’Italia 2018

Authors and Affiliations

  • Antonio Memeo
    • 1
    Email author
  • Leopoldo Pedretti
    • 1
  • Dario D’Amato
    • 1
  • Paolo Trezza
    • 1
  1. 1.ASST Ortopedico TraumatologicaPini-CTOMilanoItalia

Personalised recommendations