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Liu X, Yang H, Jun Z, Li L, Wang Z, Li Z, Liu J. Outcomes of physeal-sparing posterior cruciate ligament reconstruction for adolescents with an open physis. INTERNATIONAL ORTHOPAEDICS 2024; 48:1525-1532. [PMID: 37989809 DOI: 10.1007/s00264-023-06037-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE The posterior cruciate ligament (PCL) rupture rarely occurs, especially in skeletally immature adolescents, and poses a dilemma in appropriately managing the open physis with its vast growth potential. However, although many epiphyseal-protecting techniques for anterior cruciate ligament (ACL) reconstruction have been reported, a similar problem in PCL reconstruction has received scant attention and needs more relevant research. So, this study aims to evaluate the short-term clinical and imaging results of the arthroscopic physeal-sparing reconstruction program. METHOD All the 13 patients we reviewed in this study have accepted the arthroscopic physeal-sparing PCL reconstruction from January 2019 to December 2022 in our Department of Orthopedics. Primary demographic data collected include gender (8 males and 5 females), age (11-15 years, average 13.3 years), follow-up period (15-35 months, average 25.2 months), injury mechanism (nine non-contact injuries and four contact injuries), and days following injury (1-10 days, average 5.3 days). The assessment of clinical outcomes included pre- and postoperative physical examination, knee functional scores, and imaging data. RESULT All patients in this study were followed up with an average 25.2-month (range 15-35 months) follow-up period. All the cases preoperatively had a positive posterior drawer test and turned negative at the final follow-up. The average ROM improved from 103.6° ± 11.4° to 132.6° ± 3.6° at the last follow-up (p < 0.05). The VAS score decreased from 5.8 ± 1.6 to 0.9 ± 0.5 (p < 0.05); the average KT-1000 healthy-side to affected-side difference decreased from 11.3 ± 1.6 to1.8 ± 0.5 mm. The comparison of all the knee functional scores (IKDC, Tegner scores, and Lysholm) at preoperative and last follow-up showed a significant difference (p < 0.05). None of the cases had operation-related complications, and all recovered to sports well. CONCLUSION The arthroscopic physeal-sparing posterior cruciate ligament reconstruction is a dependable and recommended treatment for posterior cruciate ligament rupture in adolescents with open physis, showing a striking improvement in knee function without growth arrest and angular deformity of the affected limb in the short-term follow-up.
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Affiliation(s)
- Xu Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China
| | - Haibo Yang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China
| | - Zhong Jun
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China
| | - Lingzhi Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China
| | - Zhaojun Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China
| | - Zhong Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China.
| | - Juncai Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China.
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Faust TF, Castañeda PG. Arthrofibrosis of the knee in pediatric orthopedic surgery. ACTA ORTOPEDICA MEXICANA 2024; 38:179-187. [PMID: 38862148 DOI: 10.35366/115813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Arthrofibrosis is a challenging complication associated with knee injuries in both children and adults. While much is known about managing arthrofibrosis in adults, it is necessary to understand its unique aspects and management strategies in the pediatric population. This paper provides an overview of arthrofibrosis in pediatric orthopedic surgery, focusing on its causes, implications, classifications, and management. This paper is a comprehensive review of the literature and existing research on arthrofibrosis in pediatric patients. Arthrofibrosis is characterized by excessive collagen production and adhesions, leading to restricted joint motion and pain. It is associated with an immune response and fibrosis within and around the joint. Arthrofibrosis can result from various knee injuries in pediatric patients, including tibial spine fractures, ACL and PCL injuries, and extra-articular procedures. Technical factors at the time of surgery play a role in the development of motion loss and should be addressed to minimize complications. Preventing arthrofibrosis through early physical therapy is recommended. Non-operative management, including dynamic splinting and serial casting, has shown some benefits. New pharmacologic approaches to lysis of adhesions have shown promise. Surgical interventions, consisting of arthroscopic lysis of adhesions (LOA) and manipulation under anesthesia (MUA), can significantly improve motion and functional outcomes. Arthrofibrosis poses unique challenges in pediatric patients, demanding a nuanced approach that includes prevention, early intervention with non-operative means, and improvements in surgical techniques. Modern pharmacological interventions offer promise for the future. Customized interventions and research focused on pediatric patients are critical for optimal outcomes.
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Affiliation(s)
- T F Faust
- Department of Research, Alabama College of Osteopathic Medicine. Alabama, USA
| | - P G Castañeda
- Baylor School of Medicine, Department of Pediatric Orthopedic Surgery, Texas Children's Hospital. USA
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Vasudevan RS, Rupp GE, Zogby AM, Wilps T, Paras T, Pennock AT. Decreased Posterior Tibial Slope and Its Association With Pediatric Posterior Cruciate Ligament Injury. Am J Sports Med 2024; 52:1498-1504. [PMID: 38619042 DOI: 10.1177/03635465241240792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND Recent adult studies have demonstrated that decreased posterior tibial slope angle (PTSA) may be a risk factor for posterior cruciate ligament (PCL) injury. However, there is no study investigating this phenomenon in a pediatric population. Understanding risk factors for PCL injuries among a pediatric population is important given the recent rise in athletic competition/specialization and sports-related injuries. HYPOTHESIS/PURPOSE The purpose of this study was to compare PTSA between pediatric patients sustaining a primary PCL tear compared with age- and sex-matched controls. It was hypothesized that pediatric patients sustaining a PCL tear would have a decreased PTSA compared with controls, with decreased PTSA being associated with higher odds of PCL injury. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The records of all patients sustaining a PCL injury between 2006 and 2021 at a level 1 pediatric trauma center were reviewed. Patients aged ≤18 years with magnetic resonance imaging-confirmed PCL tear were included. Excluded were patients with concomitant anterior cruciate ligament tears, previous PCL reconstruction, or previous coronal plane realignment. A control cohort, with their ligament shown as intact on magnetic resonance imaging scans, was matched based on age and sex. PTSA was measured on lateral radiographs of the injured knee or tibia. The mean PTSA was compared between cohorts, and odds ratios were calculated based on the normal slope range (7°-10°) described in the literature, an upper range (>10°), and a lower range (<7°). Inter- and intrarater reliability were determined via calculation of an intraclass correlation coefficient. RESULTS Of the 98 patients who sustained a PCL injury in this study period, 59 (60%) met inclusion criteria, and 59 healthy knee controls were matched. There were no differences between the cohorts for age (P = .90), sex (P > .99), or body mass index (P = .74). The PCL cohort had a lower mean ± SD PTSA compared with the control group (5.9°± 2.7° vs 7.3°± 4.3°; P = .03). PTSA <7° was associated with a 2.8 (95% CI, 1.3-6.0; P = .01) times risk of PCL tear. Conversely, PTSA >10° was associated with a 0.27 (95% CI, 0.09-0.81; P = .02) times risk of PCL tear. These PTSA measurements demonstrated acceptable intrarater and interrater reliability. CONCLUSION PTSA <7° was associated with an increased odds of PCL injury, whereas a slope >10° was associated with a decreased odds of PCL injury in a pediatric population. These findings corroborate similar outcomes in adult studies; however, further studies are needed to elucidate PTSA as a risk factor for PCL injury.
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Affiliation(s)
- Rajiv S Vasudevan
- Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Garrett E Rupp
- Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, California, USA
- Department of Orthopedic Surgery, University of California, San Diego, San Diego, California, USA
| | - Andrew M Zogby
- Department of Orthopedic Surgery, University of California, San Diego, San Diego, California, USA
| | - Tyler Wilps
- Department of Orthopedic Surgery, University of California, San Diego, San Diego, California, USA
| | - Tyler Paras
- Department of Orthopedic Surgery, University of California, San Diego, San Diego, California, USA
| | - Andrew T Pennock
- Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, California, USA
- Department of Orthopedic Surgery, University of California, San Diego, San Diego, California, USA
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He J, Byrne K, Liang J, Lu A, Wu S. Posterior cruciate ligament rupture and all-epiphyseal repair with suture tape augmentation in a 5-year-old girl: a case report and review of the literature. BMC Pediatr 2023; 23:331. [PMID: 37386372 PMCID: PMC10308658 DOI: 10.1186/s12887-023-04146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/19/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION Only a few case reports regarding pediatric posterior cruciate ligament (PCL) ruptures without bone avulsion exist in the literature. The present study aims to share our experience in the diagnosis, treatment, and prognosis of a child with a proximal PCL tear. MATERIALS AND METHODS This article reports a 5-year-old female diagnosed with a proximal PCL tear. The ruptured PCL was repaired with an all-epiphyseal suture tape augmentation (STA) without evidence of growth plate violation. RESULTS The suture tape was removed under arthroscopy and revealed the PCL was re-attached at 12 months after the first surgery. And at the time of this report, 36 months after surgery, she was doing well without any problems and with negative posterior drawer test. CONCLUSIONS Pediatric PCL tear without bone avulsion is rare. However, the torn PCL was noticed healed based on an arthroscopic second-look.
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Affiliation(s)
- Jinshen He
- Department of Orthopaedic Surgery, the Third Xiangya Hospital of Central South University, Changsha, 410013 Hunan China
| | - Kevin Byrne
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213 USA
| | - Jiehui Liang
- Department of Orthopaedic Surgery, the Third Xiangya Hospital of Central South University, Changsha, 410013 Hunan China
| | - Anjie Lu
- Department of Orthopaedic Surgery, the Third Xiangya Hospital of Central South University, Changsha, 410013 Hunan China
| | - Song Wu
- Department of Orthopaedic Surgery, the Third Xiangya Hospital of Central South University, Changsha, 410013 Hunan China
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Anchustegui N, Grimm NL, Milbrandt TA, Rustad A, Shea C, Troyer S, Dingel AB, Ganley TJ, Fabricant PD, Shea KG. Medial and Lateral Posterior Tibial Slope in the Skeletally Immature: A Cadaveric Study. Orthop J Sports Med 2022; 10:23259671221088331. [PMID: 35400135 PMCID: PMC8984849 DOI: 10.1177/23259671221088331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/31/2021] [Indexed: 11/15/2022] Open
Abstract
Background: An increased posterior tibial slope (PTS) results in greater force on the
anterior cruciate ligament (ACL) and is a risk factor for ACL injuries.
Biomechanical studies have suggested that a reduction in the PTS angle may
lower the risk of ACL injuries. However, the majority of these
investigations have been in the adult population. Purpose: To assess the mean medial and lateral PTS on pediatric cadaveric specimens
without known knee injuries. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 39 pediatric knee specimens with computed tomography scans were
analyzed. Specimens analyzed were between the ages of 2 and 12 years. The
PTS of each specimen was measured on sagittal computed tomography slices at
2 locations for the medial and lateral angles. The measurements were plotted
graphically by age to account for the variability in development within age
groups. The anterior medial and lateral tibial plateau widths were measured.
The distance between the top of the tibial plateau and the physis was
measured. The independent-samples t test and analysis of
variance were used to analyze the measurements. Results: The mean PTS angle for the medial and lateral tibial plateaus was 5.53° ±
4.17° and 5.95° ± 3.96°, respectively. The difference between the PTS angles
of the medial and lateral tibial plateaus was not statistically significant
(P > .05). When plotted graphically by age, no trend
between age and PTS was identified. Conclusion: This data set offers values for the PTS in skeletally immature specimens
without a history of ACL injury and suggests that age may not be an accurate
predictive factor for PTS.
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Affiliation(s)
| | | | - Todd A. Milbrandt
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Audrey Rustad
- George Washington University, Washington, District of Columbia, USA
| | - Cooper Shea
- Stanford University, Stanford, California, USA
| | - Stockton Troyer
- George Washington University, Washington, District of Columbia, USA
| | - Aleksei B. Dingel
- University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | - Kevin G. Shea
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
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Scarcella MJ, Yalcin S, Scarcella NR, Saluan P, Farrow LD. Outcomes of Pediatric Posterior Cruciate Ligament Reconstruction: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211032539. [PMID: 34604428 PMCID: PMC8485165 DOI: 10.1177/23259671211032539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background Little has been reported in the literature regarding surgical treatment of posterior cruciate ligament (PCL) injuries in pediatric patients. Purpose/Hypothesis The purpose was to evaluate presentation, injury pattern, outcomes, and complications of surgically managed PCL injuries in pediatric patients. It was hypothesized that pediatric patients would have good patient-reported outcomes and no significant radiographic changes or complications. Study Design Systematic review; Level of evidence, 4. Methods A literature search was performed using PubMed, Medline, EMBASE, Scopus, and Cochrane databases between 1975 and December 16, 2019. Search terms included "posterior cruciate ligament," "peel-off injury," "avulsion," "PCL," "pediatric," "skeletally immature," and "adolescent." Included were studies on pediatric patients with PCL injuries managed operatively. Exclusion criteria included case reports, studies not reporting clinical results, reviews, abstract or conference papers, or papers not in the English language. Quality assessment was performed on all included studies using the MINORS (Methodological Index for Non-Randomized Studies) criteria. Results Four articles comprising 43 knees in 42 patients met the criteria and were included. Motor vehicle accidents were the most common mechanism of injury (39.5%; n = 17/43), followed by sports-related injuries (35%; n = 15/43). All studies commented on tear pattern, with the following distribution: 42% (n = 18/43) midsubstance tears, 37% (n = 16/43) tibial avulsions, and 21% (n = 9/43) femoral avulsions. Overall, good patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score and Pediatric International Knee Documentation Committee, Tegner, and Lysholm scores) and return to activity, as well as satisfactory posterior stability (KT-1000 arthrometer, posterior drawer test, and kneeling radiographs) and range of motion, were reported. There was no significant leg-length discrepancy or angular deformity reported. Arthrofibrosis was reported in 7% of postoperative knees and was the most commonly reported complication. Osteoarthritis was reported in 21% (n = 9/43) of knees. The average MINORS score was 7 (range, 6-8) for noncomparative studies and 10 for comparative studies. Conclusion Good patient-reported outcomes and return to activity can be obtained using repair or reconstruction. This evidence was limited by the quality of the included studies and overall small sample size; however, this review serves as a baseline for futures studies on PCL repair/reconstruction in pediatric patients.
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Affiliation(s)
| | - Sercan Yalcin
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
| | | | - Paul Saluan
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
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Longo UG, Viganò M, Candela V, de Girolamo L, Cella E, Thiebat G, Salvatore G, Ciccozzi M, Denaro V. Epidemiology of Posterior Cruciate Ligament Reconstructions in Italy: A 15-Year Study. J Clin Med 2021; 10:jcm10030499. [PMID: 33535403 PMCID: PMC7867089 DOI: 10.3390/jcm10030499] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 01/02/2023] Open
Abstract
Background: The posterior cruciate ligament (PCL) is an essential element in knee stability. PCL reconstructions represent an under-investigated topic in the literature due to the rarity of this type of knee injury. This study aims to investigate the incidence of PCL reconstructive surgeries in Italy, following their trend during a 15-year period. Methods: The National Hospital Discharge records (SDO) collected by the Italian Ministry of Health between January 2001 and October 2015 were analyzed. The database reports anonymous data comprising patients’ ages, genders, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for diagnosis and intervention, census regions, regions of hospitalization, lengths of hospitalization and types of reimbursement. Results: The overall incidence of PCL reconstructions in the Italian population during the study period was 0.46 surgeries per 100,000 inhabitants/year, ranging from 0.32 to 0.54. The median patient’s age was 30 years old, and the male:female ratio was 5.3. PCL lesions were isolated in 39.7% of patients, while anterior cruciate ligament injuries were the most frequently associated lesions (31.1%). Conclusions: The incidence of PCL reconstruction in Italy was low and stable during the study period. Young men are the category at the highest risk for these procedures. Given the paucity of epidemiological data on PCL reconstructions, this data may represent a reference for the current and foreseeable needs in PCL surgeries for countries sharing similar cultural context.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (U.G.L.); (G.S.); (V.D.)
| | - Marco Viganò
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.V.); (G.T.)
| | - Vincenzo Candela
- Medical Statistics and Molecular Epidemiology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (V.C.); (E.C.); (M.C.)
| | - Laura de Girolamo
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.V.); (G.T.)
- Correspondence: ; Tel.: +39-02-6621-4059
| | - Eleonora Cella
- Medical Statistics and Molecular Epidemiology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (V.C.); (E.C.); (M.C.)
| | - Gabriele Thiebat
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milano, Italy; (M.V.); (G.T.)
| | - Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (U.G.L.); (G.S.); (V.D.)
| | - Massimo Ciccozzi
- Medical Statistics and Molecular Epidemiology, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (V.C.); (E.C.); (M.C.)
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (U.G.L.); (G.S.); (V.D.)
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Pisanu G, Moura JL, Saithna A, Sonnery-Cottet B. Arthroscopic Repair of Proximal Posterior Cruciate Ligament Injuries in Pediatric Patients. Arthrosc Tech 2019; 8:e691-e695. [PMID: 31467838 PMCID: PMC6713858 DOI: 10.1016/j.eats.2019.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/03/2019] [Indexed: 02/03/2023] Open
Abstract
A renewed interest in arthroscopic knee ligament repair is emerging as a result of diagnostic and technical improvements. In pediatric patients with posterior cruciate ligament (PCL) injury, surgical reconstruction is rarely considered as an option because of the risk of iatrogenic physeal injury. In this Technical Note, we describe an arthroscopic surgical repair technique of PCL proximal avulsions in pediatric patients. The main reasons to consider arthroscopic PCL repair in this population include minimal surgical morbidity, preservation of the complex biomechanical properties of the native ligament, the small diameter of the bone tunnels, the physeal respecting nature of the procedure, the absence of graft harvesting, and the absence of fixation devices. The indications for this technique are limited to patients with an acute proximal PCL avulsion. Investigation performed from at Centre Orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France.
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Affiliation(s)
- Gabriele Pisanu
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Hôpital Privé Jean Mermoz, Groupe Ramsay GDS, 69008 Lyon, France
| | - João Luís Moura
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Hôpital Privé Jean Mermoz, Groupe Ramsay GDS, 69008 Lyon, France
| | - Adnan Saithna
- Advanced Orthopedics and Sports Medicine, Kansas City, Missouri, U.S.A
- School of Science and Technology, Clifton Campus, Nottingham Trent University, Nottingham, United Kingdom
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Hôpital Privé Jean Mermoz, Groupe Ramsay GDS, 69008 Lyon, France
- Address correspondence to Bertrand Sonnery-Cottet, M.D., Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Hôpital Privé Jean Mermoz, Groupe Ramsay GDS, 69008 Lyon, France.
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Surgical treatment of posterior cruciate ligament lesions does not cause growth disturbances in pediatric patients. Knee Surg Sports Traumatol Arthrosc 2019; 27:2704-2709. [PMID: 30465098 PMCID: PMC6656898 DOI: 10.1007/s00167-018-5308-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/15/2018] [Indexed: 11/04/2022]
Abstract
PURPOSE The aim of the present study was to describe epidemiology, management and outcome of pediatric and adolescent patients with posterior cruciate ligament (PCL) injuries. METHODS Sixteen patients of less than 18 years of age with 7 PCL avulsion fractures and 9 PCL tears were included over a 10-year period. Trauma mechanism, additional injuries and treatment methods were analyzed. Follow-up examination included range of motion and ability to perform squats. Pedi-IKDC and Lysholm score were obtained and posterior shift was measured in kneeling view radiographs and compared to the contralateral side. Patients were grouped into pediatric patients with open physes at the time surgery and adolescent patients with closing or closed physes. In case of open physes, growth disturbances were assessed. RESULTS Six of the treated patients (median age 12.5 years, range 10-13) had open physes at time of surgery. Five of those sustained avulsion fractures and treatment consisted of open reduction and screw fixation in four cases and graft reconstruction in one case. One patient sustained a PCL tear and underwent graft reconstruction. Follow-up at a median of 71.5 months (range 62-100) did not reveal any growth disturbances. Median Pedi-IKDC was 71.9 (range 51.7-92.1), median Lysholm score was 81.5 (range 66-88) and median posterior shift difference was 2.5 mm (range 0-11). The remaining 10 patients (median age 16 years, range 14-17) had closing/closed physis at the time of operation. Two patients presented with avulsion fractures treated with open reduction and screw fixation and 8 patients sustained PCL tears treated with graft reconstruction. At a median follow-up of 69.5 months (range 11-112), median Pedi-IKDC was 86.8 (range 36.8-97.7), median Lysholm score was 84.0 (range 45-95) and median posterior shift difference was 4 mm (range 0-15). CONCLUSIONS In our small number of pediatric patients with PCL injuries, open reduction and epiphyseal screw fixation of displaced avulsed fractures and steep tunnel drilling in case of PCL reconstruction did not cause growth disturbances. Nevertheless, long-term functional impairment should be expected and close follow-up has to be recommended. LEVEL OF EVIDENCE Therapeutic, Level IV.
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Richmond CG, Cannamela PC, Fabricant PD, Ganley TJ, Beckmann JT, Anderson AF, Shea KG. It is feasible to perform an all-epiphyseal double-bundle posterior cruciate ligament reconstruction in skeletally immature patients? A computer-aided modelling study. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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