Rupture of the anterior cruciate ligament in children: early reconstruction with open physes or delayed reconstruction to skeletal maturity?

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 17; no. 7; pp. 748 - 755
• Main Authors: Henry, Julien, Chotel, Franck, Chouteau, Julien, Fessy, Michel Henri, Bérard, Jérôme, Moyen, Bernard
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.07.2009; Springer Nature B.V; Springer Verlag
• Subjects: Adolescent; Age Determination by Skeleton; Anterior Cruciate Ligament - physiopathology; Anterior Cruciate Ligament Injuries; Athletic Injuries - surgery; Bioengineering; Bone Development; Child; Child, Preschool; Female; Humans; Knee; Life Sciences; Male; Medicine; Medicine & Public Health; Orthopedic Procedures - methods; Orthopedics; Retrospective Studies; Rupture - etiology; Rupture - surgery; Tendons - transplantation; Time Factors; Treatment Outcome; Reconstruction; Meniscus; Delayed; Surgery; Adolescent; Skeletally immature; Children; Anterior cruciate ligament; BIOMECANIQUE
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-009-0741-0

The purpose of this study was to compare two different strategies of management for ACL rupture in skeletally immature patient. In group 1, patients were treated in a children hospital by ACL reconstruction with open physis. In group 2, patients were treated in an adult hospital by delayed reconstruction at skeletal maturity assessed radiologically. Fifty-six consecutive patients were included in this retrospective study. Mean time from injury to surgery in group 1 and 2 was, respectively, 13.5 and 30 months. Patients from group 2 exhibited a higher rate of medial meniscal tears (41%) compare to group 1 (16%) and higher rate of meniscectomy. Both groups had the same rate of lateral meniscal tears. A temporary tibial valgus deformity was reported which was subsequently spontaneously resolved. No definitive growth disturbance was noticed. At 27 months mean follow-up, a best subjective IKDC score was found in group 1. Objective IKDC and radiological results were similar in both groups. Early ACL reconstruction is therefore a recommended option.