Arthroscopic anterior cruciate ligament repair for proximal anterior cruciate ligament tears in skeletally immature patients: Surgical technique and preliminary results

• Published in: The knee Vol. 24; no. 1; pp. 40 - 48
• Main Authors: Bigoni, Marco, Gaddi, Diego, Gorla, Massimo, Munegato, Daniele, Pungitore, Marco, Piatti, Massimiliano, Turati, Marco
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2017; Elsevier Limited
• Subjects: Age Factors; Anterior cruciate ligament; Anterior Cruciate Ligament Injuries - diagnostic imaging; Anterior Cruciate Ligament Injuries - physiopathology; Anterior Cruciate Ligament Injuries - surgery; Anterior Cruciate Ligament Reconstruction - methods; Arthroscopic fixation; Arthroscopy - methods; Child; Clinical outcomes; Consent; Female; Follow-Up Studies; Humans; Injuries; Knee; Ligaments; Male; NMR; Nuclear magnetic resonance; Open physes; Orthopedics; Patients; Pediatric; Pediatrics; Quality; Range of Motion, Articular; Retrospective Studies; Short term; Skin & tissue grafts; Sport injury; Surgical techniques; Suture Anchors; Treatment Outcome; Open physes; Pediatric; Anterior cruciate ligament; Sport injury; Arthroscopic fixation
• ISSN: 0968-0160; 1873-5800; 1873-5800
• DOI: 10.1016/j.knee.2016.09.017

Anterior cruciate ligament (ACL) tears in children are increasingly common and present difficult treatment decisions due to the risk of growth disturbance. Although open primary ACL repair was abandoned in the historical literature, recent studies have suggested that there is a role for arthroscopic primary repair in patients with proximal tears. This is a retrospective review of five consecutive patients aged 9.2years (range 8 to 10) who underwent suture anchor ACL reinsertion. Patients were included if they were Tanner stages 1–2 and proximal ACL tears with adequate tissue quality confirmed arthroscopically. The time frame was 81days. Arthroscopic ACL reinsertion was performed with bioabsorbable suture anchor. Clinical evaluation, KT-1000™, and MRI were re-evaluated. Clinical outcomes were measured using International Knee Documentation Committee (IKDC), Lysholm and Tegner activity score. At a mean follow-up of 43.4months (range 25 to 56), no re-injury and leg length discrepancies were observed. Four patients had negative Lachman tests. The remainder had a grade 1 Lachman test. The mean side-to-side difference was 3 (2–4mm). In MRI obtained at the last follow-up, no articular lesions or growth arrest were observed and the reinserted ACL was recognized in every exam. All patients returned to previous level of activity and presented normal and nearly normal IKDC score. The mean Lysholm score was 93.6. Arthroscopic ACL repair can achieve good short-term results with joint stability and recovery of sport activity in skeletally immature patients, with proximal ACL avulsion tear.