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Alonso-Hernández J, Galán-Olleros M, Miranda-Gorozarri C, Cabello Blanco J, Garlito-Díaz H, Manzarbeitia-Arroba P, Araúz De Robles S. Transphyseal arthroscopic anterior cruciate ligament reconstruction in children under 12 years. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05497-x. [PMID: 39174765 DOI: 10.1007/s00402-024-05497-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 08/14/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND The incidence of anterior cruciate ligament (ACL) injuries in children is on the rise. Despite this trend, the optimal management of these injuries remains a matter of ongoing debate. In this light, our study seeks to assess the clinical, radiological, and functional outcomes of transphyseal ACL reconstruction in preadolescent patients in the medium-term. METHODS This prospective study included preadolescent patients aged up to 12 years who underwent ACL transphyseal reconstruction between 2010 and 2020 and had a minimum follow-up of 2 years. Clinical assessments encompassed joint stability and range of motion. Furthermore, leg length discrepancy (LLD) and femorotibial alignment were evaluated both clinically and radiologically using full-length lower limb standing radiographs. Pre- and postoperative functional outcomes were assessed using the International Knee Documentation Committee (IKDC) and Lysholm scales, and the return to normal sports activity was evaluated using the ACL-Return to Sport after Injury (ACL-RSI) scale. Complications and relevant follow-up data were also recorded. Statistical analyses were conducted to evaluate these outcomes. RESULTS A total of 35 preadolescent patients, consisting of 24 males and 11 females, with a mean age at surgery of 11.2 ± 0.7 years (8.7-12), were included in the study. The mean follow-up was 52.3 ± 20.7 months (24.1-95.9). No significant growth disturbances or clinically relevant LLD were evidenced. All patients demonstrated clinically stable knees with full range of motion at the 2-year follow-up. There were statistically significant improvements in pre- and postoperative IKDC (39.3 ± 13.5 vs. 99.7 ± 0.8, p < 0.005) and Lysholm scores (48.2 ± 15.1 vs. 99.6 ± 1.4, p < 0.005). All but two patients were able to return to their pre-injury level of sports activity, with a mean ACL-RSI score of 93.5 ± 1.3. The analysis revealed an 8.6% rerupture rate and an 11.4% rate of contralateral ACL injuries, with 5-year survival rates of 92.3% and 88.8%, respectively. Subgroup analyses based on age, gender, surgical delay, or associated meniscal lesions did not reveal any significant differences in functional outcomes. Additionally, there was no discernible relationship between age or timing of ACL reconstruction and the risk of meniscal injuries. CONCLUSIONS Our study reinforces the value of ACL reconstruction in skeletally immature preadolescent patients, with transphyseal technique proven to be a safe, effective, and technically simpler option, even for children under the age of 12. The findings indicate excellent functional outcomes, a high rate of successful return to sporting activities, and minimal to no incidence of growth-related complications in the medium-term. LEVEL OF EVIDENCE Level II, prospective comparative cohort study, before and after intervention.
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Affiliation(s)
- Javier Alonso-Hernández
- Pediatric Orthopaedic Unit, Clínica CEMTRO, Av. Ventisquero de la Condesa 42, Madrid, 28035, Spain
- Pediatric Orthopaedic, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - María Galán-Olleros
- Pediatric Orthopaedic Unit, Clínica CEMTRO, Av. Ventisquero de la Condesa 42, Madrid, 28035, Spain.
- Pediatric Orthopaedic, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - Carlos Miranda-Gorozarri
- Pediatric Orthopaedic Unit, Clínica CEMTRO, Av. Ventisquero de la Condesa 42, Madrid, 28035, Spain
- Pediatric Orthopaedic, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Juan Cabello Blanco
- Pediatric Orthopaedic Unit, Clínica CEMTRO, Av. Ventisquero de la Condesa 42, Madrid, 28035, Spain
- Pediatric Orthopaedic, Orthopaedic Surgery and Traumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Hugo Garlito-Díaz
- Pediatric Orthopaedic Unit, Clínica CEMTRO, Av. Ventisquero de la Condesa 42, Madrid, 28035, Spain
- Pediatric Orthopaedic, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Paloma Manzarbeitia-Arroba
- Pediatric Orthopaedic Unit, Clínica CEMTRO, Av. Ventisquero de la Condesa 42, Madrid, 28035, Spain
- Pediatric Orthopaedic, Orthopaedic Surgery and Traumatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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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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Migliorini F, Pilone M, Memminger MK, Eschweiler J, Giorgino R, Maffulli N. All-epiphyseal anterior cruciate ligament reconstruction yields superior sports performances than the trans-epiphyseal technique in skeletally immature patients: a systematic review. J Orthop Traumatol 2024; 25:7. [PMID: 38376718 PMCID: PMC10879072 DOI: 10.1186/s10195-024-00751-9] [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] [Received: 07/24/2023] [Accepted: 01/13/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears in skeletally immature patients are increasingly common. Evidence comparing the outcomes of all-epiphyseal versus trans-epiphyseal ACL reconstruction in skeletally immature patients is limited, and the current literature could benefit from a comprehensive systematic review. The present study compared all-epiphyseal versus trans-epiphyseal ACL reconstruction in skeletally immature patients. The outcomes of interest were to compare joint laxity, patient-reported outcome measures (PROMs), return to sport, and complications. METHODS This study was conducted according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In November 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. No additional filters were used in the database search. All the clinical studies investigating ACL reconstruction in skeletally immature patients were accessed. Only articles that clearly stated the surgical technique (all- or trans-epiphyseal) were eligible. Only articles with a minimum of 6 months of follow-up were included. Only articles that clearly stated that surgeries were conducted in children with open physis were eligible. RESULTS Data from 1489 patients (1493 procedures) were collected, of which 32% (490 of 1489 patients) were female. The mean length of follow-up was 46.6 months. The mean age of the patients was 12.7 years. No difference was found in joint laxity (Table 3): positive pivot shift (P = 0.4), positive Lachman test (P = 0.3), and mean arthrometer laxity (P = 0.1). No difference was found in PROMs (Table 4): International Knee Documentation Committee (IKDC) (P = 0.3), Lysholm (P = 0.4), and Tegner (P = 0.7). The trans-epiphyseal technique was associated with a greater rate of patients unable to return to sports (1% versus 7%, P = 0.0001) and with a longer time to return to sports (7.7 versus 8.6 months, P = 0.01). Though the trans-epiphyseal technique was associated with a lower rate of return to sport, this difference was not statistically significant (P = 0.8). No difference was evidenced in the rate of patients who had reduced their league or level of sports activity (P = 0.6) or in the rate of patients who had returned to their previous league or level of sports activity (P = 0.7). No difference was found in the rate of complication: re-tear (P = 0.8), reoperation (P = 0.7), increased laxity (P = 0.9), and persistent instability sensation (P = 0.3). CONCLUSION Trans-epiphyseal ACL reconstruction was associated with a greater rate of patients unable to return to sport and with a longer time to return to sport compared with the all-epiphyseal technique in skeletally immature patients. Level of evidence Level III, systematic review.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
| | - Marco Pilone
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Michael Kurt Memminger
- Department of Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
- Department of Trauma and Reconstructive Surgery, BG Hospital Bergmannstrost, Halle, Germany
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Nicola Maffulli
- Department of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, ST4 7QB, Stoke on Trent, England
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, E1 4DG, London, England
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Siboni R, Pioger C, Mouton C, Seil R. Presentation of an intraosseous suspensory fixation technique for pediatric and adult ACL reconstruction. Orthop Traumatol Surg Res 2024; 110:103633. [PMID: 37121431 DOI: 10.1016/j.otsr.2023.103633] [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] [Received: 08/25/2022] [Revised: 01/24/2023] [Accepted: 03/28/2023] [Indexed: 05/02/2023]
Abstract
The aim is to present a technique for pediatric and adult ACL reconstruction using an intraosseous suspensory fixation. This technique uses a 4-strands hamstring graft fixed in the femoral tunnel, with a loop locked in a polyetheretherketone (PEEK) cage. The ACLip® device offers an inside-out drilling system and a closer fixation to the joint than an extracortical button fixation. The technique can be easily used both in adults and in skeletally immature patients. The first practical experience shows promising results regarding the safety and the effectiveness of the technique. Level of evidence: IV.
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Affiliation(s)
- Renaud Siboni
- Department of Orthopaedic Surgery, centre hospitalier Luxembourg - clinique d'Eich, 78, rue d'Eich, L-1460 Luxembourg, Luxembourg; Department of Orthopaedic Surgery, Reims teaching Hospital, hôpital Maison Blanche, 45, rue Cognacq-Jay, 51092 Reims, France
| | - Charles Pioger
- Department of Orthopaedic Surgery, centre hospitalier Luxembourg - clinique d'Eich, 78, rue d'Eich, L-1460 Luxembourg, Luxembourg; Department of Orthopaedic Surgery, Ambroise-Paré Hospital, Paris Saclay University, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Caroline Mouton
- Department of Orthopaedic Surgery, centre hospitalier Luxembourg - clinique d'Eich, 78, rue d'Eich, L-1460 Luxembourg, Luxembourg; Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Romain Seil
- Department of Orthopaedic Surgery, centre hospitalier Luxembourg - clinique d'Eich, 78, rue d'Eich, L-1460 Luxembourg, Luxembourg; Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg; Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg, Luxembourg.
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Xiao Y, Tang H, Wu Y, Meng J, Liu W, Gao S. How to predict the dimensions of anterior cruciate ligament in children based on MRI? Medicine (Baltimore) 2023; 102:e35028. [PMID: 37960762 PMCID: PMC10637532 DOI: 10.1097/md.0000000000035028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/09/2023] [Indexed: 11/15/2023] Open
Abstract
There are many studies examining the dimensions of the anterior cruciate ligament (ACL) in children. The correlations between the ACL size in children and other parameters are not well understood. To detect the correlations between the ACL size in children and other parameters including age, gender, bone and soft tissue parameters through measurements on MRI images, and to establish prediction models for the ACL size. A total of 99 patients who underwent MRI scan were included (39 girls, 60 boys; mean age, 13.01 ± 3.94; range of age, 4 to 18). The following measurements were taken on MRI images by 2 observers: ACL length, ACL width, posterior cruciate ligament (PCL) length, the distance from the most anterior aspect of the tibial epiphysis to the anterior aspect of the ACL tibial insertion (AATI), the distance from the most anterior aspect of the tibial epiphysis to the posterior aspect of the ACL tibial insertion (APTI), and the tibial anteroposterior diameter (AP). Correlations between these measurements and the patients' gender and age were investigated, and univariate and multiple linear regression models were established accordingly. Before 13 years old, the ACL length was significantly correlated with the tibial anteroposterior diameter and age (R2 = 0.872, P < .001), and there were no statistically significant gender differences. After 13 years old, the ACL length was significantly correlated with the PCL length and APTI in males (R2 = 0.443, P < .001), and with the PCL length in females (R2 = 0.443, P < .001). In children under 13 years old, there was no significant gender difference in ACL length, and the tibial anteroposterior diameter and age were found to be important indicators in assessing the ACL size. After 13 years old, a significant gender difference in ACL length was observed, and the ACL length was found to be weakly correlated with age and bone parameters. In order to accurately evaluate the ACL size in children aged 13 years and above, it is necessary to refer to the dimensions of the ACL on the collateral side.
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Affiliation(s)
- Yifan Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hang Tang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yumei Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiahao Meng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weijie Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shuguang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Madry H. Shaping experimental orthopaedics. J Exp Orthop 2023; 10:95. [PMID: 37743440 PMCID: PMC10518299 DOI: 10.1186/s40634-023-00658-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Henning Madry
- Institute of Experimental Orthopaedics, Saarland University, Kirrberger Straße, Building 37, 66421, Homburg, Saar, Germany.
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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. J Exp Orthop 2023; 10:7. [PMID: 36695820 PMCID: PMC9877258 DOI: 10.1186/s40634-023-00577-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Aim of this systematic review was to analyze the outcome after transphyseal ACL reconstruction in children and adolescents regarding the femoral drilling technique. METHODS A systematic literature search was carried out in various databases on studies on transphyseal ACL reconstruction in children and adolescents. The literature search was limited to the last 20 years. Primary outcome criterion was the failure rate. Secondary outcome criteria were growth disturbances such as leg length discrepancies or deformities and clinical scores. The present study was registered prospectively ( www.crd.york.ac.uk/PROSPERO ; CRD42022345964). RESULTS A total of 22 retrospective or prospective case series (level 4 evidence) were identified that reported on transphyseal ACL reconstruction in children and adolescents. The overall failure/rupture rate after transphyseal ACL reconstruction was 11.0%. The overall ACL rupture rate of the contralateral side was 9.7%. No statistical significant difference in the failure rates between independent and transtibial drilling techniques could be detected ((p = 0.76/p = 0.28)). Furthermore no statistical significant differences in the rate of reported growth disturbances between independent and transtibial drilling techniques were shown (p = 0.15). The reported clinical scores at follow-up (mean follow-up 5.05 years) revealed good to very good results. CONCLUSION This systematic review demonstrates that children and adolescents have a relatively high failure rate after transpyseal ACL reconstruction without any statistically significant differences between independent or transtibial drilling techniques regarding reruptur rates or the rate of growth disturbances. The results of this systematic review warrant a comparison of both techniques for femoral tunnel drilling in a controlled randomized trial.
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Affiliation(s)
- Wolf Petersen
- grid.461755.40000 0004 0581 3852Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar Theyß Strasse 27-31, 14193 Berlin, Grunewald, Berlin Germany
| | - Sebastian Bierke
- grid.461755.40000 0004 0581 3852Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar Theyß Strasse 27-31, 14193 Berlin, Grunewald, Berlin Germany
| | - Amelie Stöhr
- Orthopädische Chirurgie München, Munich, Germany
| | | | - Martin Häner
- grid.461755.40000 0004 0581 3852Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar Theyß Strasse 27-31, 14193 Berlin, Grunewald, Berlin Germany
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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 2023; 31:206-218. [PMID: 35838794 DOI: 10.1007/s00167-022-07032-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/30/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim of this meta-analysis was to evaluate complete transphyseal (CTP), partial transphyseal (PTP), and physeal-sparing (PS) techniques for anterior cruciate ligament (ACL) reconstruction. METHODS A systematic literature search of the PubMed, Web of Science, Cochrane Library, and Scopus literature databases was performed on 10.05.2021. All human studies evaluating the outcomes of CTP, PTP, and PS techniques were included. The influence of the selected approach was evaluated in terms of rates of retears, return to previous level of sport competition, IKDC subjective and objective scores, Lysholm score, rate of normal Lachman and pivot-shift tests, limb length discrepancy, and hip-knee angle (HKA) deviation. Risk of bias and quality of evidence were assessed following the Downs and Black checklist. RESULTS Forty-nine out of 425 retrieved studies (3260 patients) met the inclusion criteria. The results of the meta-analysis comparing CTP, PTP, and PS approaches for ACL reconstruction in the under 20-year-old population showed a significant difference in terms of differential laxity (CTP 1.98 mm, PTP 1.69 mm, PS 0.22 mm, p < 0.001). No significant differences were seen in terms of growth malalignment, rate of normal Lachman and pivot-shift tests, and rate of normal/quasi-normal IKDC objective score. CONCLUSIONS The present meta-analysis found overall similar results with the three ACL reconstruction approaches. The PS technique showed better results in terms of knee laxity than the PTP and CTP approaches, but this did not lead to a significant difference in terms of subjective and objective scores. No clear superiority of one technique over the others was found with respect to re-ruptures, growth disturbances, and axial deviations. While the argument for avoiding growth malalignment does not seem to be a crucial point, the PS technique should be the preferred approach in a young population to ensure knee laxity restoration. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Gherardo Pagliazzi
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Department of Paediatric Orthopaedics, University of Basel Children's Hospital, Basel, Switzerland
| | - Marco Cuzzolin
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Luca Pacchiarini
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland.
| | - Marco Delcogliano
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Marigi EM, Song BM, Wasserburger JN, Camp CL, Levy BA, Stuart MJ, Okoroha KR, Krych AJ. Anterior Cruciate Ligament Reconstruction in 107 Competitive Wrestlers: Outcomes, Reoperations, and Return to Play at 6-Year Follow-up. Orthop J Sports Med 2022; 10:23259671221092770. [PMID: 35547615 PMCID: PMC9083060 DOI: 10.1177/23259671221092770] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/17/2021] [Indexed: 11/15/2022] Open
Abstract
Background Wrestling is a physically demanding sport, with young athletes prone to anterior cruciate ligament (ACL) injuries. There is a paucity of data evaluating the results of ACL reconstruction (ACLR) in this cohort. Purpose To assess return to sport (RTS), patient-reported outcomes, reoperation rates, and graft survival after ACLR in a large cohort of competitive wrestlers at midterm follow-up. Study Design Case series; Level of evidence, 4. Methods We identified all competitive wrestlers (club, high school, collegiate, or professional) with a history of an ACLR at a single institution between 2000 and 2019. Graft failure was defined as a retear (as determined via clinical or advanced imaging evaluation) and/or revision ACLR. All patients were contacted for determination of reinjury rates; current sport status; and pain visual analog scale, International Knee Documentation Committee, and Tegner activity scores. Results Included were 107 knees in 103 wrestlers, with a median follow-up time of 5.9 years (interquartile range [IQR], 3.9-10.3 years). The median age was 17 years (IQR, 15-18 years), with 106 (99%) male patients, and the distribution of bone-patellar tendon-bone (BTB) and hamstring tendon (HT) autografts was 64 (60%) and 43 (40%), respectively. At final follow-up, 80% of athletes were able to RTP at a median of 280 days (IQR, 212-381 days). Graft failure occurred in 14 (13%) knees at a median time of 1.8 years (IQR, 0.7-5.3 years) after the index ACLR. BTB autograft demonstrated a lower failure rate compared with HT autograft (8% vs 21%; P = .044) and was associated with better survival compared with HT autograft up to 15 years after the index ACLR (90.4% vs 76.3%; P = .030). When compared by graft diameter, HT autografts of at least 7.5 mm were not associated with a lower graft failure than BTB constructs of all sizes (P = .205). Conclusion Return to competitive wrestling was observed in 80% of athletes after ACLR, with 14% of wrestlers experiencing graft failure. BTB autograft was associated with better survival than HT autograft.
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Affiliation(s)
- Erick M. Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryant M. Song
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Bruce A. Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J. Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelechi R. Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Aaron J. Krych, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA () (Twitter: @DrKrych)
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10
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Cancino B, Muñoz C, Tuca MJ, Birrer EAM, Sepúlveda MF. Anterior Cruciate Ligament Rupture in Skeletally Immature Patients. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202205000-00007. [PMID: 35588096 PMCID: PMC10531303 DOI: 10.5435/jaaosglobal-d-21-00166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 03/15/2022] [Indexed: 06/15/2023]
Abstract
In the past 20 years, sports injuries in pediatric and adolescent athletes have increased dramatically, with anterior cruciate ligament (ACL) injuries accounting for more than 25% of all knee injuries at this age. Diagnosis is based on detailed clinical history, physical examination, and imaging assessment, where magnetic resonance imaging plays a central role. The growing immature skeleton presents specific characteristics, which require unique methods for surgical reconstruction, ideally avoiding the physes or minimizing the risk of damaging them. Specific rehabilitation protocols are needed, and these patients face a higher risk of recurrent and contralateral ACL injury. Nonsurgical treatment or delayed reconstruction has been associated with persistent instability, activity modifications, worst functional outcomes, and increased risk of irreparable injuries to menisci and articular cartilage. Consequently, surgical stabilization is the preferred treatment for most patients, despite the eventual risk of angular deformities or limb-length discrepancies due to iatrogenic physeal injury. A variety of surgical techniques have been described, depending on the skeletal maturity and growth remaining. Targeted prevention programs play a key role in reducing the risk of ACL injury, are easy to implement, and require no additional equipment. High-quality evidence supports its use in all pediatric athletes.
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Affiliation(s)
- Benjamín Cancino
- From the Universidad Austral de Chile, Valdivia, Chile (Dr. Cancino, Dr. Muñoz, Dr. Birrer, and Dr. Sepúlveda); the Clínica Alemana, Santiago, Chile (Dr. Tuca); the Universidad del Desarrollo, Santiago, Chile (Dr. Tuca); the Hospital Clínico Mutual de Seguridad, Santiago, Chile (Dr. Tuca); and Hospital Base de Valdivia, Valdivia, Chile (Dr. Birrer, and Dr. Sepúlveda)
| | - Carlos Muñoz
- From the Universidad Austral de Chile, Valdivia, Chile (Dr. Cancino, Dr. Muñoz, Dr. Birrer, and Dr. Sepúlveda); the Clínica Alemana, Santiago, Chile (Dr. Tuca); the Universidad del Desarrollo, Santiago, Chile (Dr. Tuca); the Hospital Clínico Mutual de Seguridad, Santiago, Chile (Dr. Tuca); and Hospital Base de Valdivia, Valdivia, Chile (Dr. Birrer, and Dr. Sepúlveda)
| | - María Jesús Tuca
- From the Universidad Austral de Chile, Valdivia, Chile (Dr. Cancino, Dr. Muñoz, Dr. Birrer, and Dr. Sepúlveda); the Clínica Alemana, Santiago, Chile (Dr. Tuca); the Universidad del Desarrollo, Santiago, Chile (Dr. Tuca); the Hospital Clínico Mutual de Seguridad, Santiago, Chile (Dr. Tuca); and Hospital Base de Valdivia, Valdivia, Chile (Dr. Birrer, and Dr. Sepúlveda)
| | - Estefanía A. M. Birrer
- From the Universidad Austral de Chile, Valdivia, Chile (Dr. Cancino, Dr. Muñoz, Dr. Birrer, and Dr. Sepúlveda); the Clínica Alemana, Santiago, Chile (Dr. Tuca); the Universidad del Desarrollo, Santiago, Chile (Dr. Tuca); the Hospital Clínico Mutual de Seguridad, Santiago, Chile (Dr. Tuca); and Hospital Base de Valdivia, Valdivia, Chile (Dr. Birrer, and Dr. Sepúlveda)
| | - Matías F. Sepúlveda
- From the Universidad Austral de Chile, Valdivia, Chile (Dr. Cancino, Dr. Muñoz, Dr. Birrer, and Dr. Sepúlveda); the Clínica Alemana, Santiago, Chile (Dr. Tuca); the Universidad del Desarrollo, Santiago, Chile (Dr. Tuca); the Hospital Clínico Mutual de Seguridad, Santiago, Chile (Dr. Tuca); and Hospital Base de Valdivia, Valdivia, Chile (Dr. Birrer, and Dr. Sepúlveda)
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11
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The incidence of paediatric ACL injury is increasing in Finland. Knee Surg Sports Traumatol Arthrosc 2020; 28:363-368. [PMID: 31222395 PMCID: PMC6994437 DOI: 10.1007/s00167-019-05553-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 06/05/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) injury is a common knee injury in paediatric and adolescent patients. The population-based incidence of paediatric ACL injury is, however, unknown. Recent studies suggest increased ACL injury rates among adolescents, especially in active, sports-participating population. The purpose of this study was to investigate the population-based incidence rates of ACL injuries and trends in paediatric ACL reconstruction surgery. METHOD All ACL injuries were identified (ICD-10 diagnosis code S83.5) leading to hospitalisation or surgery using validated Finnish National Hospital Discharge Register (NHDR) data from 1997 to 2014. The sample comprised 19,961,205 Finnish residents aged less than 18 years at the time of injury. Hospital admissions with the diagnosis code S83.5 were analysed more thoroughly including, sex, age and the need for surgical interventions. RESULTS During the 18-year study period, 4725 subjects of the study population had sustained an ACL injury. The total ACL injury incidence in study population was 23.3 per 100,000 person-years. The median age of the patients at the time of injury was 16 years (range 4-17). The incidence of ACL injury increased with age, and the highest incidence was observed among 17-year old (113.5 per 100,000 person-years). Incidence rate did not differ between genders. From the total ACL injury population of 4725 hospitalisations, 3168 (67.0%) underwent ACL reconstruction, of which 2988 (94.3%) were treated with arthroscopic reconstruction and 180 (5.6%) with open surgery. In addition, 1557 (33.0%) were treated non-operatively without ACL reconstruction. The annual incidence of ACL injuries in the Finnish paediatric population has increased during the past 15 years. The lowest incidence rate was seen in 1999 (incidence of 17.7 per 100,000 person-years, 195 ACL injuries) and the highest in 2011 (incidence of 31.5 per 100,000 person-years, 346 ACL injuries). The highest increase in ACL injuries was seen in girls aged 13-15 years, with an increase of 143%. CONCLUSION ACL injury is not a negligible knee injury in the paediatric population. The incidence of paediatric ACL injury has increased during the past 15 years. Moreover, a twofold increase in incidence of paediatric ACL injury was noted during the last 10 years of the study period. Incidence rates among male and female paediatric patients were comparable. LEVEL OF EVIDENCE III.
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12
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Ardern CL, Ekås G, Grindem H, Moksnes H, Anderson AF, Chotel F, Cohen M, Forssblad M, Ganley TJ, Feller JA, Karlsson J, Kocher MS, LaPrade RF, McNamee M, Mandelbaum B, Micheli L, Mohtadi NG, Reider B, Roe JP, Seil R, Siebold R, Silvers-Granelli HJ, Soligard T, Witvrouw E, Engebretsen L. 2018 International Olympic Committee Consensus Statement on Prevention, Diagnosis, and Management of Pediatric Anterior Cruciate Ligament Injuries. Orthop J Sports Med 2018; 6:2325967118759953. [PMID: 29594177 PMCID: PMC5865521 DOI: 10.1177/2325967118759953] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In October 2017, the International Olympic Committee hosted an international expert group of physical therapists and orthopaedic surgeons who specialize in treating and researching pediatric anterior cruciate ligament (ACL) injuries. The purpose of this meeting was to provide a comprehensive, evidence-informed summary to support the clinician and help children with ACL injury and their parents/guardians make the best possible decisions. Representatives from the following societies attended: American Orthopaedic Society for Sports Medicine; European Paediatric Orthopaedic Society; European Society for Sports Traumatology, Knee Surgery, and Arthroscopy; International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine; Pediatric Orthopaedic Society of North America; and Sociedad Latinoamericana de Artroscopia, Rodilla, y Deporte. Physical therapists and orthopaedic surgeons with clinical and research experience in the field and an ethics expert with substantial experience in the area of sports injuries also participated. This consensus statement addresses 6 fundamental clinical questions regarding the prevention, diagnosis, and management of pediatric ACL injuries. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision making with children and the potential long-term ramifications of the injury.
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Affiliation(s)
| | - Clare L. Ardern
- Clare L. Ardern, PT, PhD, Division of Physiotherapy, Linköping University, Linköping, Sweden (ORCID ID: 0000-0001-8102-3631) ()
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13
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Ardern CL, Ekås G, Grindem H, Moksnes H, Anderson AF, Chotel F, Cohen M, Forssblad M, Ganley TJ, Feller JA, Karlsson J, Kocher MS, LaPrade RF, McNamee M, Mandelbaum B, Micheli L, Mohtadi N, Reider B, Roe J, Seil R, Siebold R, Silvers-Granelli HJ, Soligard T, Witvrouw E, Engebretsen L. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. J ISAKOS 2018. [DOI: 10.1136/jisakos-2018-000200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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14
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Ardern CL, Ekås GR, Grindem H, Moksnes H, Anderson AF, Chotel F, Cohen M, Forssblad M, Ganley TJ, Feller JA, Karlsson J, Kocher MS, LaPrade RF, McNamee M, Mandelbaum B, Micheli L, Mohtadi N, Reider B, Roe J, Seil R, Siebold R, Silvers-Granelli HJ, Soligard T, Witvrouw E, Engebretsen L. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. Br J Sports Med 2018; 52:422-438. [PMID: 29478021 PMCID: PMC5867447 DOI: 10.1136/bjsports-2018-099060] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 12/25/2022]
Abstract
In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric ACL injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery & Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions.
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Affiliation(s)
- Clare L Ardern
- Division of Physiotherapy, Linköping University, Linköping, Sweden.,School of Allied Health, La Trobe University, Melbourne, Australia
| | - Guri Ranum Ekås
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Sciences, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege Grindem
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Håvard Moksnes
- Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Franck Chotel
- Department of Pediatric Orthopaedic Surgery, Hôpital Femme Mere Enfant, Lyon, France
| | - Moises Cohen
- Orthopedic Department, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Magnus Forssblad
- Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden
| | - Theodore J Ganley
- Department of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Julian A Feller
- OrthoSport Victoria Research Unit, Epworth Healthcare, Melbourne, Australia.,College of Science, Health & Engineering, La Trobe University, Melbourne, Australia
| | - Jón Karlsson
- Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Minider S Kocher
- Division of Sports Medicine, Boston Children's Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, USA.,The Steadman Clinic, Vail, USA
| | | | - Bert Mandelbaum
- Santa Monica Orthopaedic and Sports Medicine Group, Los Angeles, USA
| | - Lyle Micheli
- Division of Sports Medicine, Boston Children's Hospital, Boston, USA.,Harvard Medical School, Boston, USA.,The Micheli Center for Sports Injury Prevention, Waltham, USA
| | | | - Bruce Reider
- Department of Orthopaedics and Rehabilitation Medicine, University of Chicago, Chicago, USA
| | - Justin Roe
- North Sydney Orthopaedic & Sports Medicine Centre, Sydney, Australia
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg, Luxembourg.,Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg
| | - Rainer Siebold
- Institute for Anatomy and Cell Biology, Ruprecht-Karls-University, Heidelberg, Germany.,HKF International Center for Hip, Knee, Foot Surgery and Sports Traumatology, ATOS Klinik, Heidelberg, Germany
| | | | - Torbjørn Soligard
- Medical & Scientific Department, International Olympic Committee, Chateau de Vidy, Lausanne, Switzerland.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Erik Witvrouw
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
| | - Lars Engebretsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Sciences, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Medical & Scientific Department, International Olympic Committee, Chateau de Vidy, Lausanne, Switzerland
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15
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Xiong Y, Lang Y, Yu Z, Liu H, Fang X, Tu C, Duan H. The effects of surgical treatment with chondroblastoma in children and adolescents in open epiphyseal plate of long bones. World J Surg Oncol 2018; 16:14. [PMID: 29361956 PMCID: PMC5781291 DOI: 10.1186/s12957-018-1314-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 01/10/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Chondroblastoma is a rare benign cartilaginous tumor, which primarily occurs in children and adolescents. Chondroblastoma commonly originates in the epiphyseal plate of long bones. An aggressive curettage treatment is recommended to manage lesion, which may jeopardize an open epiphyseal plate and result in limb shortening and deformity as the limb grows and develops. The purpose is to observe surgical effects of chondroblastoma on open epiphyseal plate of long bones in children and adolescents and explore influences on limb growth and development. METHODS We retrospectively reviewed 18 cases of long bone chondroblastoma with open epiphyseal growth plate during March 2004 to October 2010 in our center. Seven females and 11 males with mean age of 11.6 ± 2.0 years old (8-15 years) were included. Patients, who suffered from trauma and pathological fracture of the epiphyseal plate or congenital diseases such as poliomyelitis, congenital dementia, and cartilage malnutrition, were excluded. All patients were treated with meticulous intralesional curettage and inactivity with alcohol followed by bone grafts. All cases were followed up 8.2 ± 1.7 years (5-11.5 years). RESULTS All had no local recurrence and distance metastasis. The length of the affected limb was short, 18.47 ± 7.22 mm (1.5-30 mm). There was no obvious relativity with tumor activity (P = 0.061). Meanwhile, there were obvious relativity with the greatest dimension of the lesion (TGD) (P = 0.003), the vertical dimension between edge of lesion and epiphyseal line (TVD) (P = 0.010), and area ratio of lesion to local epiphysis (lesion/growth plate) (P = 0.015). The MSTS93 (Revised Musculoskeletal Tumor Society Rating Scale 93) and SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey) had been significantly improved (P < 0.01). CONCLUSION Managing of chondroblastoma located in open epiphyseal plate of a long bone with meticulous curettage, inactivity, and bone grafts can control tumor progression and recurrence effectively. Meanwhile, early detection and prompt surgical treatment intervention, which reduced significantly the tumor to influence limb growth and development, get encouraging limb function. TRIAL REGISTRATION This is a retrospective study, which was not registered in any trial registry.
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Affiliation(s)
- Yan Xiong
- Department of Orthopedics, West China Hospital, Sichuan University, No 37 Guo Xue Lane, Wuhou District, 610041, Chengdu, Sichuan, People's Republic of China
| | - Yun Lang
- Department of Orthopedics, West China Hospital, Sichuan University, No 37 Guo Xue Lane, Wuhou District, 610041, Chengdu, Sichuan, People's Republic of China
| | - Zeping Yu
- Department of Orthopedics, West China Hospital, Sichuan University, No 37 Guo Xue Lane, Wuhou District, 610041, Chengdu, Sichuan, People's Republic of China
| | - Hongyuan Liu
- Department of Orthopedics, West China Hospital, Sichuan University, No 37 Guo Xue Lane, Wuhou District, 610041, Chengdu, Sichuan, People's Republic of China
| | - Xiang Fang
- Department of Orthopedics, West China Hospital, Sichuan University, No 37 Guo Xue Lane, Wuhou District, 610041, Chengdu, Sichuan, People's Republic of China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, No 37 Guo Xue Lane, Wuhou District, 610041, Chengdu, Sichuan, People's Republic of China
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, No 37 Guo Xue Lane, Wuhou District, 610041, Chengdu, Sichuan, People's Republic of China.
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16
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Hamrin Senorski E, Seil R, Svantesson E, Feller JA, Webster KE, Engebretsen L, Spindler K, Siebold R, Karlsson J, Samuelsson K. "I never made it to the pros…" Return to sport and becoming an elite athlete after pediatric and adolescent anterior cruciate ligament injury-Current evidence and future directions. Knee Surg Sports Traumatol Arthrosc 2018; 26:1011-1018. [PMID: 29188332 PMCID: PMC5876277 DOI: 10.1007/s00167-017-4811-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/20/2017] [Indexed: 12/04/2022]
Abstract
The management of anterior cruciate ligament (ACL) injuries in the skeletally immature and adolescent patient remains an area of controversy in sports medicine. This study, therefore, summarizes and discusses the current evidence related to treating pediatric and adolescent patients who sustain an ACL injury. The current literature identifies a trend towards ACL reconstruction as the preferred treatment option for ACL injuries in the young, largely justified by the risk of further structural damage to the knee joint. Worryingly, a second ACL injury is all too common in the younger population, where almost one in every three to four young patients who sustain an ACL injury and return to high-risk pivoting sport will go on to sustain another ACL injury. The clinical experience of these patients emphasizes the rarity of an athlete who makes it to elite level after a pediatric or adolescent ACL injury, with or without reconstruction. If these patients are unable to make it to an elite level of sport, treatment should possibly be modified to take account of the risks associated with returning to pivoting and strenuous sport. The surveillance of young athletes may be beneficial when it comes to reducing injuries. Further research is crucial to better understand specific risk factors in the young and to establish independent structures to allow for unbiased decision-making for a safe return to sport after ACL injury. Level of evidence V.
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Affiliation(s)
- Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Romain Seil
- 0000 0004 0621 531Xgrid.451012.3Sports Medicine Research Laboratory, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Eleonor Svantesson
- 0000 0000 9919 9582grid.8761.8Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Julian A. Feller
- 0000 0001 0459 5396grid.414539.eOrthoSport Victoria, Epworth HealthCare, Melbourne, VIC Australia
| | - Kate E. Webster
- 0000 0001 2342 0938grid.1018.8School of Allied Health, La Trobe University, Melbourne, VIC Australia
| | - Lars Engebretsen
- 0000 0004 0389 8485grid.55325.34Oslo University Hospital and University of Oslo, Oslo, Norway ,0000 0000 8567 2092grid.412285.8OSTRC, The Norwegian School of Sports Sciences, Oslo, Norway
| | - Kurt Spindler
- 0000 0001 0675 4725grid.239578.2Cleveland Clinic Sports Health Center, Garfield Heights, OH USA
| | - Rainer Siebold
- 0000 0001 2190 4373grid.7700.0Institute for Anatomy and Cell Biology, Ruprecht-Karls-University, Heidelberg, Germany ,HKF, International Center for Hip, Knee, Foot Surgery and Sportstraumatology, ATOS Klinik, Heidelberg, Germany
| | - Jón Karlsson
- 0000 0000 9919 9582grid.8761.8Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,000000009445082Xgrid.1649.aDepartment of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Gothenburg, Sweden
| | - Kristian Samuelsson
- 0000 0000 9919 9582grid.8761.8Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,000000009445082Xgrid.1649.aDepartment of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Gothenburg, Sweden
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17
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Ardern CL, Ekås G, Grindem H, Moksnes H, Anderson A, Chotel F, Cohen M, Forssblad M, Ganley TJ, Feller JA, Karlsson J, Kocher MS, LaPrade RF, McNamee M, Mandelbaum B, Micheli L, Mohtadi N, Reider B, Roe J, Seil R, Siebold R, Silvers-Granelli HJ, Soligard T, Witvrouw E, Engebretsen L. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. Knee Surg Sports Traumatol Arthrosc 2018; 26:989-1010. [PMID: 29455243 PMCID: PMC5876259 DOI: 10.1007/s00167-018-4865-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/05/2018] [Indexed: 12/11/2022]
Abstract
In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric anterior cruciate ligament (ACL) injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery and Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America, and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis, and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions.
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Affiliation(s)
- Clare L. Ardern
- 0000 0001 2162 9922grid.5640.7Division of Physiotherapy, Linköping University, Linköping, Sweden ,0000 0001 2342 0938grid.1018.8School of Allied Health, La Trobe University, Melbourne, Australia
| | - Guri Ekås
- 0000 0004 0389 8485grid.55325.34Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway ,0000 0000 8567 2092grid.412285.8Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Sciences, Oslo, Norway ,0000 0004 1936 8921grid.5510.1Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege Grindem
- 0000 0000 8567 2092grid.412285.8Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Håvard Moksnes
- 0000 0000 8567 2092grid.412285.8Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Franck Chotel
- grid.414103.3Department of Pediatric Orthopaedic Surgery, Hôpital Femme Mere Enfant, Lyon, France
| | - Moises Cohen
- 0000 0001 0514 7202grid.411249.bOrthopedic Department, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Magnus Forssblad
- 0000 0004 1937 0626grid.4714.6Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden
| | - Theodore J. Ganley
- 0000 0001 0680 8770grid.239552.aDepartment of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, USA
| | - Julian A. Feller
- 0000 0001 0459 5396grid.414539.eOrthoSport Victoria Research Unit, Epworth Healthcare, Melbourne, Australia ,0000 0001 2342 0938grid.1018.8College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Jón Karlsson
- 0000 0000 9919 9582grid.8761.8Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mininder S. Kocher
- 0000 0004 0378 8438grid.2515.3Division of Sports Medicine, Boston Children’s Hospital, Boston, USA ,000000041936754Xgrid.38142.3cHarvard Medical School, Boston, USA
| | - Robert F. LaPrade
- 0000 0001 0367 5968grid.419649.7Steadman Philippon Research Institute, Vail, USA ,0000 0001 0027 3736grid.419648.6The Steadman Clinic, Vail, USA
| | - Mike McNamee
- 0000 0001 0658 8800grid.4827.9College of Engineering, Swansea University, Swansea, UK
| | - Bert Mandelbaum
- Santa Monica Orthopaedic and Sports Medicine Group, Los Angeles, USA
| | - Lyle Micheli
- 0000 0004 0378 8438grid.2515.3Division of Sports Medicine, Boston Children’s Hospital, Boston, USA ,000000041936754Xgrid.38142.3cHarvard Medical School, Boston, USA ,The Micheli Center for Sports Injury Prevention, Waltham, USA
| | - Nicholas Mohtadi
- 0000 0004 1936 7697grid.22072.35University of Calgary Sports Medicine Centre, Calgary, Canada
| | - Bruce Reider
- 0000 0004 1936 7822grid.170205.1Department of Orthopaedics and Rehabilitation Medicine, University of Chicago, Chicago, USA
| | - Justin Roe
- 0000 0004 0382 8241grid.420075.4North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
| | - Romain Seil
- 0000 0004 0578 0421grid.418041.8Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg, Luxembourg City, Luxembourg ,0000 0004 0621 531Xgrid.451012.3Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg City, Luxembourg
| | - Rainer Siebold
- 0000 0001 2190 4373grid.7700.0Institute for Anatomy and Cell Biology, Ruprecht-Karls-University, Heidelberg, Germany ,HKF International Center for Hip, Knee, Foot Surgery and Sportstraumatology, ATOS Klinik, Heidelberg, Germany
| | | | - Torbjørn Soligard
- 0000 0004 0626 1762grid.469323.9Medical and Scientific Department, International Olympic Committee, Chateau de Vidy, Lausanne, Switzerland ,0000 0004 1936 7697grid.22072.35Faculty of Kinesiology, Sports Injury Prevention Centre, University of Calgary, Calgary, Alberta Canada
| | - Erik Witvrouw
- 0000 0001 2069 7798grid.5342.0Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Healthscience, Ghent University, Ghent, Belgium
| | - Lars Engebretsen
- 0000 0004 0389 8485grid.55325.34Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway ,0000 0000 8567 2092grid.412285.8Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Sciences, Oslo, Norway ,0000 0004 1936 8921grid.5510.1Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,0000 0004 0626 1762grid.469323.9Medical and Scientific Department, International Olympic Committee, Chateau de Vidy, Lausanne, Switzerland
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Shaw N, Erickson C, Bryant SJ, Ferguson VL, Krebs MD, Hadley-Miller N, Payne KA. Regenerative Medicine Approaches for the Treatment of Pediatric Physeal Injuries. TISSUE ENGINEERING PART B-REVIEWS 2017; 24:85-97. [PMID: 28830302 DOI: 10.1089/ten.teb.2017.0274] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The physis, or growth plate, is a cartilaginous region at the end of children's long bones that serves as the primary center for longitudinal growth and characterizes the immature skeleton. Musculoskeletal injury, including fracture, infection, malignancy, or iatrogenic damage, has risk of physeal damage. Physeal injuries account for 30% of pediatric fractures and may result in impaired bone growth. Once damaged, cartilage tissue within the physis is often replaced by unwanted bony tissue, forming a "bony bar" that can lead to complications such as complete growth arrest, angular or rotational deformities, and altered joint mechanics. Children with a bony bar occupying <50% of the physis usually undergo bony bar resection and insertion of an interpositional material, such as a fat graft, to prevent recurrence and allow the surrounding uninjured physeal tissue to restore longitudinal bone growth. Clinical success for this procedure is <35% and often the bony bar and associated growth impairments return. Children who are not candidates for bony bar resection due to a physeal bar occupying >50% of their physis undergo corrective osteotomy or bone lengthening procedures. These approaches are complex and have variable success rates. As such, there is a critical need for regenerative approaches to not only prevent initial bony bar formation but also regenerate healthy physeal cartilage following injury. This review describes physeal anatomy, mechanisms of physeal injury, and current treatment options with associated limitations. Furthermore, we provide an overview of the current research using cell-based therapies, growth factors, and biomaterials in the different animal models of injury along with strategic directions for modulating intrinsic injury pathways to inhibit bony bar formation and/or promote physeal tissue formation. Pediatric physeal injuries constitute a unique niche within regenerative medicine for which there is a critical need for research to decrease child morbidity related to this injurious process.
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Affiliation(s)
- Nichole Shaw
- 1 Department of Orthopedics, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Christopher Erickson
- 1 Department of Orthopedics, University of Colorado Anschutz Medical Campus , Aurora, Colorado.,2 Department of Bioengineering, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Stephanie J Bryant
- 3 Department of Chemical and Biological Engineering, University of Colorado Boulder , Boulder, Colorado.,4 BioFrontiers Institute, University of Colorado Boulder , Boulder, Colorado.,5 Material Science and Engineering Program, University of Colorado Boulder , Boulder, Colorado
| | - Virginia L Ferguson
- 4 BioFrontiers Institute, University of Colorado Boulder , Boulder, Colorado.,5 Material Science and Engineering Program, University of Colorado Boulder , Boulder, Colorado.,6 Department of Mechanical Engineering, University of Colorado Boulder , Boulder, Colorado
| | - Melissa D Krebs
- 7 Department of Chemical and Biological Engineering, Colorado School of Mines , Golden, Colorado.,8 Gates Center for Regenerative Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Nancy Hadley-Miller
- 1 Department of Orthopedics, University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Karin A Payne
- 1 Department of Orthopedics, University of Colorado Anschutz Medical Campus , Aurora, Colorado.,8 Gates Center for Regenerative Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado
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Sinikumpu JJ, Serlo W. Biodegradable poly-L-lactide-co-glycolide copolymer pin fixation of a traumatic patellar osteochondral fragment in an 11-year-old child: A novel surgical approach. Exp Ther Med 2017; 13:242-246. [PMID: 28123496 DOI: 10.3892/etm.2016.3934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 07/21/2016] [Indexed: 11/06/2022] Open
Abstract
Treating displaced patellar bone fractures in growing children remains a challenge for orthopedic surgeons. Removal of loose bone fragments may prolong healing time and result in early onset osteoarthrosis. Therefore, primary fixation of osteochondral fragments is preferred. Metallic pin and screw implants are typically used for fixation, as there is little evidence available regarding the use of modern biodegradable implants in traumatic patellar fractures of a premature skeleton. The present report describes a novel operative technique using headless poly-L-lactide-co-glycolide (PLGA) pins in treating an 11-year-old girl with a patellar fracture from a cycling injury. The surgical technique of this procedure is described in detail in the current report. Excellent subjective outcomes were achieved from this surgery, with superb bone healing according to follow-up radiographic and computerized tomography scans. In conclusion, the results of this case indicate that, similarly to osteochondritis, intra-articular osteochondral fractures in children may be fixed using biodegradable PLGA pins. Randomized clinical trials should be performed to confirm this finding and evaluate the use of PLGA pins as a treatment for adolescent osteochondral fractures.
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Affiliation(s)
- Juha-Jaakko Sinikumpu
- Department of Pediatric Surgery and Orthopedics, Oulu University Hospital, Oulu, 90029 OYS, Finland
| | - Willy Serlo
- Department of Pediatric Surgery and Orthopedics, Oulu University Hospital, Oulu, 90029 OYS, Finland
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Falciglia F, Panni AS, Giordano M, Aulisa AG, Guzzanti V. Anterior cruciate ligament reconstruction in adolescents (Tanner stages 2 and 3). Knee Surg Sports Traumatol Arthrosc 2016; 24:807-14. [PMID: 26860104 DOI: 10.1007/s00167-016-4034-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Management of anterior cruciate ligament injuries in skeletally immature patients (in Tanner stages 2 and 3) is controversial. Conventional reconstruction used in adults can cause iatrogenic growth disturbance due to physeal damage, and studies that report long-term results using a specific technique are scarce. The aim of this study is to evaluate in a large series the mid- and long-term results of a partial transphyseal technique and define the safe percentage of lesions of the femoral growth plate. METHODS Between 1989 and 2012, 42 adolescents at risk of growth disturbances (growth prediction of lower limbs >5 cm-Tanner 2, 3) underwent reconstruction of the anterior cruciate ligament using the semitendinosus and gracilis tendons. Growth characteristics of all the patients were assessed preoperatively, and the percentage of damage that would be produced in the femoral physis by the drilling of a 6-mm-diameter tunnel was determined. The technique used achieved graft fixation at both insertion sites, drilling the femoral physis and avoiding the tibial physis. We distinguished two groups: (a) long-term follow-up (mean 13 years 7 months, min 10.9, max 16.2) and (b) medium follow-up (mean 6 years 3 months, min 3.7, max 9.9). All knees were evaluated subjectively by history and objectively by KT2000 testing, and X-rays of both knees were compared for osteoarthritis using the Kellgren-Lawrence classification. RESULTS In group A (12 patients) one osteoarthritis grade 2, one instability, and ten good stability and function were observed. The mean KT2000 arthrometer values at 30 lb showed a difference of +2.4 mm (range 1-4 mm) between the operated and non-operated sides (p < 0.05). In group B (21 patients) no growth disturbance of the lower limbs, two failures (reinjury while participating in pivoting sports), and 19 good stability and function were observed. The mean KT2000 arthrometer values at 30 lb showed a difference of +1.9 mm (range 1-5 mm) between the operated and non-operated sides (p < 0.05). The average IKDC score of all the patients was 90 (min: 68, max: 97). None of the adolescents had consequences on growth after an eccentric damage passing tendons less than 7% on the frontal plane and of 1% on cross-sectional area of the femoral physis, and after an oblique tunnel passing 6-mm-diameter tendons of the tibial epiphyseal nucleus. CONCLUSIONS This study defines the possibility to perform a partial transphyseal intra-articular ACL reconstruction in patients in Tanner stages 2 and 3 that avoids tibial physis, involves the distal femoral physis, and produces good results at mid- and long-term follow-up without causing growth disturbances. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Francesco Falciglia
- Orthopaedics and Traumatology Department, Institute of Scientific Research, Bambino Gesù Children's Hospital, Piazza San Onofrio 4, 00165, Rome, Italy.
| | - Alfredo Schiavone Panni
- University of Molise, via Francesco De Sanctis, 1, 86100, Campobasso, Italy.,Orthopaedic Clinic, Molise University, via Francesco De Sanctis, 1, 86100, Campobasso, Italy
| | - Marco Giordano
- Orthopaedics and Traumatology Department, Institute of Scientific Research, Bambino Gesù Children's Hospital, Piazza San Onofrio 4, 00165, Rome, Italy
| | - Angelo Gabriele Aulisa
- Orthopaedics and Traumatology Department, Institute of Scientific Research, Bambino Gesù Children's Hospital, Piazza San Onofrio 4, 00165, Rome, Italy
| | - Vincenzo Guzzanti
- Orthopaedics and Traumatology Department, Institute of Scientific Research, Bambino Gesù Children's Hospital, Piazza San Onofrio 4, 00165, Rome, Italy.,University of Cassino, via G. Marconi, 10, 03043, Cassino, Italy
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