Partial Tears of the Anterior Cruciate Ligament in Children and Adolescents

Author:

Kocher Mininder S.12,Micheli Lyle J.1,Zurakowski David1,Luke Anthony1

Affiliation:

1. Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts

2. Harvard School of Public Health, Boston, Massachusetts

Abstract

Background: The functional outcome after partial anterior cruciate ligament tears in children and adolescents treated without reconstruction has not been established. Hypothesis: Nonreconstructive management of partial anterior cruciate ligament tears can be effective in certain pediatric patients. Study Design: Prospective cohort study. Methods: We studied 45 skeletally mature and immature patients 17 years of age or less who had an acute hemarthrosis, magnetic resonance imaging signal changes, grade A or B Lachman and pivot shift result, and an arthroscopically documented partial anterior cruciate ligament tears. All patients were treated without reconstruction, underwent a structured rehabilitation program, and were followed up for a minimum of 2 years. Results: Fourteen patients (31%) underwent subsequent reconstruction. Significant associations with subsequent reconstruction included tears that were greater than 50%, predominantly posterolateral tears, a grade B pivot shift test result, and older chronologic and skeletal age. Among patients who did not require reconstruction, those with tears that were greater than 50% or predominantly posterolateral had significantly lower Lysholm, satisfaction, and Cincinnati Knee Scale scores. Conclusions: Nonreconstructive management is recommended for partial anterior cruciate ligament tears in children and adolescents 14 years of skeletal age or younger with normal or near-normal Lachman and pivot shift results. Reconstruction is recommended in older athletes or in those with greater than 50% or predominantly posterolateral tears.

Publisher

SAGE Publications

Subject

Physical Therapy, Sports Therapy and Rehabilitation,Orthopedics and Sports Medicine

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