Abstract
ACL injury risk in young athletes is probably multifactorial. Although ACL injury rates increase with age in both genders, girls have higher rates immediately after their growth spurt.
The management of ACL deficiency in skeletally mature children is still controversial, especially in terms of operative timing and surgical technique. Conservative management is not recommended, as it is accompanied by marked reduction in activity, decline in functional performance, and development of early osteoarthritis.
The present trend favors early reconstruction, using either extraphyseal techniques in very young athletes or anatomical reconstruction techniques placing the tibial and femoral tunnels close to the center on the growth plate of the tibia and femur in young athletes closer to skeletal maturity. No consensus exists on the best method to treat an ACL tear in a pediatric athlete. Safe and effective surgical techniques continue to evolve. However, the current literature suggests reasonable, evidenced-based management options that minimize the risks of iatrogenic growth plate injury. The two principal ACL surgery techniques performed on a pediatric athlete are physeal spearing or transphyseal and all-inside.
The authors evaluated, in a group of adolescents, the onset of varus-valgus deviations in the sagittal plane after performing a transtibial transepiphyseal technique of ACL reconstruction with a follow-up of at least 2 years.
The transtibial transepiphyseal technique of ACL reconstruction, according to the results obtained, seems to be a valid alternative procedure, when performed by a skilled orthopedic surgeon, offering an excellent safety profile and at the same time very good clinical results.
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References
Waldén M, Hägglund M, Werner J, Ekstrand J (2011) The epidemiology of anterior cruciate ligament injury in football (soccer): a review of the literature from a gender-related perspective. Knee Surg Sports Traumatol Arthrosc 19(1):3–10
Hewett TE, Zazulak BT, Myer GD (2007) Effects of the menstrual cycle on anterior cruciate ligament injury risk: a systematic review. Am J Sports Med 35(4):659–668
Myer GD, Ford KR, Hewett TE (2005) The effects of gender on quadriceps muscle activation strategies during a maneuver that mimics a high ACL injury risk position. Electromyogr Kinesiol 15(2):181–189
Nylan JA, Caborn DN, Shapiro R, Johnson DL (1997) Fatigue after eccentric quadriceps femoris work produces earlier gastrocnemius and delayed quadriceps femoris activation during crossover cutting among normal athletic women. KSSTA 5(3):162–167
Shelbourne KD, Davis TJ, Klootwyk TE (1998) The relationship between intercondylar notch width of the femur and the incidence of anterior cruciate ligament tears. A prospective study. Am J Sports Med 26(3):402–408
Lombardo S, Sethi PM, Starkey C (2005) Intercondylar notch stenosis is not a risk factor for anterior cruciate ligament tears in professional male basketball players: an 11-years prospective study. Am J Sports Med 33(1):29–34
Trimble MH, Bishop MD, Buckley BD, Fields LC, Rozea GD (2002) The relationship between clinical measurements of lower extremity posture and tibial translation. Clinical Biomech 17(4):286–290
Soderman K, Alfredson H, Pietila T, Werner S (2001) Risk factors for leg injuries in female soccer players: a prospective investigation during one out-door season. KSSTA 9(5):313–321
Boden BP, Dean GS, Feagin GA Jr, Garret WE Jr (2000) Mechanism of anterior cruciate ligament injury. Orthopedics 23:573–578
Kocher MS, Saxon HS, Hovis WD, Hawkins RJ (2002) Management and complications of anterior cruciate ligament injuries in skeletally immature patients: survey of herodicus society and the ACL study group. J Pediatric Orthop 22:452–457
Pressman AE, Letts RM, Jarvis JG (1997) Anterior cruciate ligament tears in children: an analysis of operative versus nonoperative treatment. J Pediat Orthop 17:505–511
Kaeding CC, Flanigan D, Donaldson C (2010) Surgical techniques and outcome after anterior cruciate ligament reconstruction in preadolescent patients. Arthroscopy 26:1530–1538
Frosch KH, Stengel D, Brodhun T (2010) Outcomes and risks of operative treatment of rupture of anterior cruciate ligament in children and adolescents. Arthroscopy 26(11):1539–1550
Kocher MS, Smith JT, Zoric BJ, Lee B, Micheli LJ (2007) Transphyseal anterior cruciate ligament reconstruction in skeletally immature pubescent adolescent. JBJS Am 89(12):2632–2639
Volpi P, Galli M, Bait C, Pozzoni R (2004) Surgical treatment of anterior cruciate ligament injuries in adolescents using double-looped semitendinosus and gracilis tendons: supraepiphysary femoral and tibial fixation. Arthroscopy 20(4):447–449
Anderson AF (2004) Transepiphyseal replacement of the anterior cruciate ligament using quadruple hamstring grafts in skeletally immature patients. JBJS Am 86(A(pt 2 suppl 1)):201–209
Brief LP (1991) Anterior cruciate ligament reconstruction without drill holes. Arthroscopy 7(4):350–357
Kocher MS, Garg S, Micheli LJ (2006) Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescent. Surgical technique. J Bone Joint Surg Am 88(Suppl 1 Pt 2):283–293
Micheli LJ, Rask B, Gerberg L (1999) Anterior cruciate ligament reconstruction in patients who are prepubescent. Clin Orthop Relat Res 364:40–47
Duri ZA, Patel DV, Aichroth PM (2002) The immature athlete. Clin Sports Med 21(3):461–482
McCarthy MM, Graziano J, Green DW, Cordasco FA (2012) All-epiphyseal, all-inside anterior cruciate ligament reconstruction technique for skeletally immature patients. Arthroscopy Tech 1(2):e231–e239
Lubowitz JH, Schwartzberg R, Smith P (2013) Randomized controlled trial comparing all-inside anterior cruciate ligament reconstruction technique with anterior cruciate ligament reconstruction with a full tibial tunnel. Arthroscopy 29(7):1195–1200
Tanner JM, Davies PS (1985) Clinical longitudinal standards for height and height velocity for North American children. J Pediatrics 107(3):317–329
Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 45(7):596–606
Granan LP, Forssblad M, Lind M, Engebretsen L (2009) The Scandinavian ACL registries 2004–2007: baseline epidemiology. Acta Othop 80(5):563–567
LaBella CR, Henrikus W, Hewett TE (2014) Anterior cruciate ligament injuries: diagnosis, treatment and prevention. Pediatrics 133, e1437
Hewett TE, Myer GD, Ford KR (2004) Decrease in neuromuscular control about the knee with maturation in female athletes. JBJS Am 86-A(8):1601–1608
Chotel F, Seil R (2013) Growth disturbances after transphyseal ACL reconstruction in skeletally immature patients: who is more at risk? Young child or adolescent? J Pediatr Orthop 33(5):585–586
Shea KG, Pfeiffer R, Wang JH, Curtin M, Apel PJ (2004) Anterior cruciate ligament injury in pediatric and adolescent soccer players: an analysis of insurance data. J Pediatr Orthop 24(6):623–628
Lohmander LS, Englund PM, Dahl LL, Roos EM (2007) The long term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med 35(10):1756–1769
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Bait, C., Denti, M., Orgiani, A., Carimati, G., Volpi, P. (2015). Anterior Cruciate Ligament Lesions in Adolescent. In: Volpi, P. (eds) Football Traumatology. Springer, Cham. https://doi.org/10.1007/978-3-319-18245-2_17
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DOI: https://doi.org/10.1007/978-3-319-18245-2_17
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