Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-08-2020 | Arthroscopy and Sports Medicine

ACL injuries before 15 years of age: could the young become an athlete?

Authors: Antoine Morvan, Nicolas Bouguennec, Nicolas Graveleau

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 8/2020

Abstract

Purpose

The purpose of this study was to systematically assess the possibility for a patient younger than 15 to return to a competitive level of sport following an ACL injury.

Methods

Four databases were analyzed (PubMed, MedLine, Cinahl, Cochrane Library and LISTA). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used to guide the screening of the literature. Studies about functional and surgical treatments were included with a minimum of 5 years of mean follow-up. Methodological quality of individual studies was assessed with the Methodological Index for Non-Randomized Studies scale.

Results

Ten studies were included, corresponding to a total of 217 patients. All studies were retrospective with level 4 evidence. Seven studies reported results of a transphyseal technique reconstruction, two studies a physeal-sparing reconstruction, and one studied the results of a repair (« healing response »). Only one study compared functional treatment and surgery. The mean age of patients at the time of surgery was 12.29 years (range 2–16) with a mean follow-up of 7.9 years (range 5.5–18.3). Return to sport was possible for 80 to 100% of patients (average of 91.7%) at the final follow-up but the level for return to sport was reported in only four studies and found between 61 and 89% for return to the same level and at 42% for return to a competitive level. Evolution of the Tegner score was analyzed in five studies and was reported to decrease at the follow-up in three studies. ACL re-ruptures can be considered as failure of the graft (nine studies with surgical technique) and occurred with an average of 16%.

Conclusion

This review demonstrate that ACL reconstruction is superior to conservative treatment and 'healing response' in terms of revision rates and knee laxity. Return to sport is possible for more than 4/5 of patients but only two thirds of them were able to return to the same level or to competitive level, and failure rates of the graft were not superior to global population. However, qualities of included studies and variability of treatment limited the clinical application of results. Despite this, patients and parents should be informed that ACL injuries are lesions that may influence the level of sport at a 5-year follow-up.

Level of evidence

Level IV, systematic review.

Dodwell ER, Lamont LE, Green DW, Pan TJ, Marx RG, Lyman S (2014) 20 years of pediatric anterior cruciate ligament reconstruction in New York State. Am J Sports Med 42:675–680. https://doi.org/10.1177/0363546513518412 CrossRefPubMed

Majewski M, Susanne H, Klaus S (2006) Epidemiology of athletic knee injuries: a 10-year study. Knee 13:184–188. https://doi.org/10.1016/j.knee.2006.01.005 CrossRefPubMed

Stracciolini A, Stein CJ, Zurakowski D, Meehan WP, Myer GD, Micheli LJ (2015) Anterior cruciate ligament injuries in pediatric athletes presenting to sports medicine clinic: a comparison of males and females through growth and development. Sports Health 7:130–136. https://doi.org/10.1177/1941738114554768 CrossRefPubMedPubMedCentral

Werner BC, Yang S, Looney AM, Gwathmey FW (2016) Trends in pediatric and adolescent anterior cruciate ligament injury and reconstruction. J Pediatr Orthop 36:447–452. https://doi.org/10.1097/BPO.0000000000000482 CrossRefPubMed

Brophy RH, Stepan JG, Silvers HJ, Mandelbaum BR (2015) Defending puts the anterior cruciate ligament at risk during soccer: a gender-based analysis. Sports Health 7:244–249. https://doi.org/10.1177/1941738114535184 CrossRefPubMedPubMedCentral

Morgan MD, Salmon LJ, Waller A, Roe JP, Pinczewski LA (2016) Fifteen-year survival of endoscopic anterior cruciate ligament reconstruction in patients aged 18 years and younger. Am J Sports Med 44:384–392. https://doi.org/10.1177/0363546515623032 CrossRefPubMed

Krutsch W, Zellner J, Baumann F, Pfeifer C, Nerlich M, Angele P (2017) Timing of anterior cruciate ligament reconstruction within the first year after trauma and its influence on treatment of cartilage and meniscus pathology. Knee Surg Sports Traumatol Arthrosc 25:418–425. https://doi.org/10.1007/s00167-015-3830-2 CrossRefPubMed

Wong SE, Feeley BT, Pandya NK (2019) Complications after pediatric ACL reconstruction: a meta-analysis. J Pediatr Orthop 39:e566–e571. https://doi.org/10.1097/BPO.0000000000001075 CrossRefPubMed

Faunø P, Rahr-Wagner L, Lind M (2014) Risk for revision after anterior cruciate ligament reconstruction is higher among adolescents: results from the danish registry of knee ligament reconstruction. Orthop J Sports Med 2:2325967114552405. https://doi.org/10.1177/2325967114552405 CrossRefPubMedPubMedCentral

10.

Webster KE, Feller JA, Leigh WB, Richmond AK (2014) Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction. Am J Sports Med 42:641–647. https://doi.org/10.1177/0363546513517540 CrossRefPubMed

11.

Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD (2016) Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med 44:1861–1876. https://doi.org/10.1177/0363546515621554 CrossRefPubMedPubMedCentral

12.

Aronowitz ER, Ganley TJ, Goode JR, Gregg JR, Meyer JS (2000) Anterior cruciate ligament reconstruction in adolescents with open physes. Am J Sports Med 28:168–175. https://doi.org/10.1177/03635465000280020601 CrossRefPubMed

13.

Graf BK, Lange RH, Fujisaki CK, Landry GL, Saluja RK (1992) Anterior cruciate ligament tears in skeletally immature patients: meniscal pathology at presentation and after attempted conservative treatment. Arthroscopy 8:229–233. https://doi.org/10.1016/0749-8063(92)90041-9 CrossRefPubMed

14.

Ardern CL, Taylor NF, Feller JA, Webster KE (2014) Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 48:1543–1552. https://doi.org/10.1136/bjsports-2013-093398 CrossRefPubMed

15.

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716. https://doi.org/10.1046/j.1445-2197.2003.02748.x CrossRefPubMed

16.

Bonnard C, Fournier J, Babusiaux D, Planchenault M, Bergerault F, de Courtivron B (2011) Physeal-sparing reconstruction of anterior cruciate ligament tears in children: results of 57 cases using patellar tendon. J Bone Joint Surg Br 93:542–547. https://doi.org/10.1302/0301-620X.93B4.25801 CrossRefPubMed

17.

Placella G, Bartoli M, Peruzzi M, Speziali A, Pace V, Cerulli G (2016) Return to sport activity after anterior cruciate ligament reconstruction in skeletally immature athletes with manual drilling original all inside reconstruction at 8 years follow-up. Acta Orthop Traumatol Turc 50:635–638. https://doi.org/10.1016/j.aott.2016.03.006 CrossRefPubMedPubMedCentral

18.

Calvo R, Figueroa D, Gili F, Vaisman A, Mocoçain P, Espinosa M et al (2015) Transphyseal anterior cruciate ligament reconstruction in patients with open physes: 10-year follow-up study. Am J Sports Med 43:289–294. https://doi.org/10.1177/0363546514557939 CrossRefPubMed

19.

Demange MK, Camanho GL (2014) Nonanatomic anterior cruciate ligament reconstruction with double-stranded semitendinosus grafts in children with open physes: minimum 15-year follow-up. Am J Sports Med 42:2926–2932. https://doi.org/10.1177/0363546514550981 CrossRefPubMed

20.

Streich NA, Barié A, Gotterbarm T, Keil M, Schmitt H (2010) Transphyseal reconstruction of the anterior cruciate ligament in prepubescent athletes. Knee Surg Sports Traumatol Arthrosc 18:1481–1486. https://doi.org/10.1007/s00167-010-1057-9 CrossRefPubMed

21.

Kumar S, Ahearne D, Hunt DM (2013) Transphyseal anterior cruciate ligament reconstruction in the skeletally immature: follow-up to a minimum of sixteen years of age. J Bone Joint Surg Am 95:e1. https://doi.org/10.2106/JBJS.K.01707 CrossRefPubMed

22.

Lo IK, Kirkley A, Fowler PJ, Miniaci A (1997) The outcome of operatively treated anterior cruciate ligament disruptions in the skeletally immature child. Arthroscopy 13:627–634. https://doi.org/10.1016/s0749-8063(97)90191-2 CrossRefPubMed

23.

Micheli LJ, Rask B, Gerberg L (1999) Anterior cruciate ligament reconstruction in patients who are prepubescent. Clin Orthop Relat Res. https://doi.org/10.1097/00003086-199907000-00006 CrossRefPubMed

24.

Steadman JR, Cameron-Donaldson ML, Briggs KK, Rodkey WG (2006) A minimally invasive technique (“healing response”) to treat proximal ACL injuries in skeletally immature athletes. J Knee Surg 19:8–13. https://doi.org/10.1055/s-0030-1248070 CrossRefPubMed

25.

Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 45:596–606. https://doi.org/10.1136/bjsm.2010.076364 CrossRefPubMed

26.

Kvist J (2004) Rehabilitation following anterior cruciate ligament injury: current recommendations for sports participation. Sports Med 34:269–280. https://doi.org/10.2165/00007256-200434040-00006 CrossRefPubMed

27.

Kvist J, Ek A, Sporrstedt K, Good L (2005) Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 13:393–397. https://doi.org/10.1007/s00167-004-0591-8 CrossRefPubMed

28.

Frank JS, Gambacorta PL (2013) Anterior cruciate ligament injuries in the skeletally immature athlete: diagnosis and management. J Am Acad Orthop Surg 21:78–87. https://doi.org/10.5435/JAAOS-21-02-78 CrossRefPubMed

29.

Edwards PH, Grana WA (2001) Anterior cruciate ligament reconstruction in the immature athlete: long-term results of intra-articular reconstruction. Am J Knee Surg 14:232–237PubMed

30.

Holwein C, Hinterwimmer S, Mayr HO, Lämmle L, Brucker PU, Münch EO et al (2016) Functional outcome after transphyseal anterior cruciate ligament reconstruction in young patients with open growth plates. Knee 23:1121–1132. https://doi.org/10.1016/j.knee.2016.09.001 CrossRefPubMed

31.

Larson CM, Heikes CS, Ellingson CI, Wulf CA, Giveans MR, Stone RM et al (2016) Allograft and autograft transphyseal anterior cruciate ligament reconstruction in skeletally immature patients: outcomes and complications. Arthroscopy 32:860–867. https://doi.org/10.1016/j.arthro.2015.10.014 CrossRefPubMed

32.

McCullough KA, Phelps KD, Spindler KP, Matava MJ, Dunn WR, Parker RD et al (2012) Return to high school- and college-level football after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) cohort study. Am J Sports Med 40:2523–2529. https://doi.org/10.1177/0363546512456836 CrossRefPubMedPubMedCentral

33.

Nikolaou P, Kalliakmanis A, Bousgas D, Zourntos S (2011) Intraarticular stabilization following anterior cruciate ligament injury in children and adolescents. Knee Surg Sports Traumatol Arthrosc 19:801–805. https://doi.org/10.1007/s00167-010-1375-y CrossRefPubMed

34.

Shea KG, Pfeiffer R, Wang JH, Curtin M, Apel PJ (2004) Anterior cruciate ligament injury in pediatric and adolescent soccer players: an analysis of insurance data. J Pediatr Orthop 24:623–628. https://doi.org/10.1097/00004694-200411000-00005 CrossRefPubMed

35.

Johnston DR, Ganley TJ, Flynn JM, Gregg JR (2002) Anterior cruciate ligament injuries in skeletally immature patients. Orthopedics 25:864–871PubMed

36.

Millett PJ, Willis AA, Warren RF (2002) Associated injuries in pediatric and adolescent anterior cruciate ligament tears: does a delay in treatment increase the risk of meniscal tear? Arthroscopy 18:955–959. https://doi.org/10.1053/jars.2002.36114 CrossRefPubMed

37.

Mizuta H, Kubota K, Shiraishi M, Otsuka Y, Nagamoto N, Takagi K (1995) The conservative treatment of complete tears of the anterior cruciate ligament in skeletally immature patients. J Bone Joint Surg Br 77:890–894CrossRefPubMed

38.

Pressman AE, Letts RM, Jarvis JG (1997) Anterior cruciate ligament tears in children: an analysis of operative versus nonoperative treatment. J Pediatr Orthop 17:505–511PubMed

39.

Kay J, Memon M, Marx RG, Peterson D, Simunovic N, Ayeni OR (2018) Over 90 % of children and adolescents return to sport after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 26:1019–1036. https://doi.org/10.1007/s00167-018-4830-9 CrossRefPubMed

40.

Kay J, Memon M, Shah A, Yen Y-M, Samuelsson K, Peterson D et al (2018) Earlier anterior cruciate ligament reconstruction is associated with a decreased risk of medial meniscal and articular cartilage damage in children and adolescents: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 26:3738–3753. https://doi.org/10.1007/s00167-018-5012-5 CrossRefPubMed

41.

Barrett AM, Craft JA, Replogle WH, Hydrick JM, Barrett GR (2011) Anterior cruciate ligament graft failure: a comparison of graft type based on age and Tegner activity level. Am J Sports Med 39:2194–2198. https://doi.org/10.1177/0363546511415655 CrossRefPubMed

42.

Bourke HE, Gordon DJ, Salmon LJ, Waller A, Linklater J, Pinczewski LA (2012) The outcome at 15 years of endoscopic anterior cruciate ligament reconstruction using hamstring tendon autograft for “isolated” anterior cruciate ligament rupture. J Bone Joint Surg Br 94:630–637. https://doi.org/10.1302/0301-620X.94B5.28675 CrossRefPubMed

43.

Shelbourne KD, Gray T, Haro M (2009) Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med 37:246–251. https://doi.org/10.1177/0363546508325665 CrossRefPubMed

44.

Anderson AF, Anderson CN (2015) Correlation of meniscal and articular cartilage injuries in children and adolescents with timing of anterior cruciate ligament reconstruction. Am J Sports Med 43:275–281. https://doi.org/10.1177/0363546514559912 CrossRefPubMed

45.

Dumont GD, Hogue GD, Padalecki JR, Okoro N, Wilson PL (2012) Meniscal and chondral injuries associated with pediatric anterior cruciate ligament tears: relationship of treatment time and patient-specific factors. Am J Sports Med 40:2128–2133. https://doi.org/10.1177/0363546512449994 CrossRefPubMed

46.

Guenther ZD, Swami V, Dhillon SS, Jaremko JL (2014) Meniscal injury after adolescent anterior cruciate ligament injury: how long are patients at risk? Clin Orthop Relat Res 472:990–997. https://doi.org/10.1007/s11999-013-3369-9 CrossRefPubMed

47.

Lawrence JTR, Argawal N, Ganley TJ (2011) Degeneration of the knee joint in skeletally immature patients with a diagnosis of an anterior cruciate ligament tear: is there harm in delay of treatment? Am J Sports Med 39:2582–2587. https://doi.org/10.1177/0363546511420818 CrossRefPubMed

48.

Goddard M, Bowman N, Salmon LJ, Waller A, Roe JP, Pinczewski LA (2013) Endoscopic anterior cruciate ligament reconstruction in children using living donor hamstring tendon allografts. Am J Sports Med 41:567–574. https://doi.org/10.1177/0363546512473576 CrossRefPubMed

Title: ACL injuries before 15 years of age: could the young become an athlete?
Authors: Antoine Morvan
Nicolas Bouguennec
Nicolas Graveleau
Publication date: 01-08-2020
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 8/2020
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-020-03404-8

At a glance: The STEP trials

Springer Medicine

ACL injuries before 15 years of age: could the young become an athlete?

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 8/2020

Functional outcome and tendon integrity of rotator cuff reconstruction after primary traumatic glenohumeral dislocation

Comparison of outcomes between nonsurgical and surgical treatment of distal radius fracture: a systematic review update and meta-analysis

Preoperative deltoid assessment by contrast-enhanced ultrasound (CEUS) as predictor for shoulder function after reverse shoulder arthroplasty: a prospective pilot study

Patient-specific instrument for unicompartmental knee arthroplasty does not reduce the outliers in alignment or improve postoperative function: a meta-analysis and systematic review

Additional benefits of multiple-dose tranexamic acid to anti-fibrinolysis and anti-inflammation in total knee arthroplasty: a randomized controlled trial

Is revision total hip arthroplasty through the direct anterior approach feasible?