Hi -
There are many sources of information on this subject. In summary,
ACL injuries are becoming more common, or at least more commonly
recognized in the skeletally-immature (ie children, adolescents).
These injuries can lead to the same types of long-term complications
as are seen in adults, ie joint instability and further ligamentous
injury (tears in the meniscus and other supporting ligaments).
Surgery on joints appears to be controversial in skeletally-immature
(adolescents) patients due to the risk of damaging the growth plates
(epiphysis) and thus leading to limb asymmetry (ie disfigured joints
and/or impaired growth leading to length differences in the legs) due
to impaired growth of the operated limb. Techniques do exist,
however, to treat and repair the ACL in adolescents that are felt to
minimize the risk of growth plate injury. Depending upon the severity
of the injury, the risk of surgery may be outweighed by the risk of
joint instability and its subsequent complications.
An approachable page from an orthopedist in Kentucky:
http://www.louisvillebones.com/pedacl.html
A good page discussing the types of injuries and the associated
treatment possibilites:
http://www.physsportsmed.com/issues/1996/04_96/nicholas.htm
An article on knee injuries in adolescents which discusses the
controversy surrounding the best method of managment:
http://www.intermountainortho.com/clients/io/art_shea_kneekids.html
A discussion of the operative and non-operative treatment (although
leaning towards the former) of ACL injuries in the adolescent:
http://www.aana.org/concepts/articles/ACL_immature_larson.html
A page from the University of Washington's orthopedics department
summmarizing ACL injuries in children: (the associated links are also
useful)
http://www.orthop.washington.edu/faculty/Simonian/aclchildrentechnical/03
A nice page summarizing current treatment from a sports-medicine
orthopedist in Canada:
http://www.carletonsportsmed.com/ACL%20Injury%20in%20Skeletally%20Immature%20Athletes%20AANA01.htm
The 23 most recent articles on the subject in the MEDLINE database:
1: Kocher MS, Saxon HS, Hovis WD, Hawkins RJ. Related Articles,
Links
Management and complications of anterior cruciate ligament injuries in
skeletally immature patients: survey of the Herodicus Society and The
ACL Study Group.
J Pediatr Orthop. 2002 Jul-Aug;22(4):452-7.
PMID: 12131440 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12131440&dopt=Abstract
2: Shea KG, Apel PJ, Pfeiffer RP, Showalter LD, Traughber PD. Related
Articles, Links
The tibial attachment of the anterior cruciate ligament in children
and adolescents: analysis of magnetic resonance imaging.
Knee Surg Sports Traumatol Arthrosc. 2002 Mar;10(2):102-8.
PMID: 11914768 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11914768&dopt=Abstract
3: Andrish JT. Related Articles, Links
Anterior cruciate ligament injuries in the skeletally immature
patient.
Am J Orthop. 2001 Feb;30(2):103-10. Review.
PMID: 11234936 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11234936&dopt=Abstract
4: Edwards PH, Grana WA. Related Articles, Links
Anterior cruciate ligament reconstruction in the immature athlete:
long-term results of intra-articular reconstruction.
Am J Knee Surg. 2001 Fall;14(4):232-7.
PMID: 11703036 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11703036&dopt=Abstract
5: Hawkins CA, Rosen JE. Related Articles, Links
ACL injuries in the skeletally immature patient.
Bull Hosp Jt Dis. 2000;59(4):227-31.
PMID: 11409242 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11409242&dopt=Abstract
6: Seil R, Kohn D. Related Articles, Links
[Ruptures of the anterior cruciate ligament (ACL) during growth]
Bull Soc Sci Med Grand Duche Luxemb. 2000;(1):39-53. Review. French.
PMID: 11200311 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11200311&dopt=Abstract
7: Fehnel DJ, Johnson R. Related Articles, Links
Anterior cruciate injuries in the skeletally immature athlete: a
review of treatment outcomes.
Sports Med. 2000 Jan;29(1):51-63. Review.
PMID: 10688283 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10688283&dopt=Abstract
8: Simonian PT, Metcalf MH, Larson RV. Related Articles, Links
Anterior cruciate ligament injuries in the skeletally immature
patient.
Am J Orthop. 1999 Nov;28(11):624-8.
PMID: 10588469 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10588469&dopt=Abstract
9: Lo IK, Bell DM, Fowler PJ. Related Articles, Links
Anterior cruciate ligament injuries in the skeletally immature
patient.
Instr Course Lect. 1998;47:351-9. Review.
PMID: 9571437 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9571437&dopt=Abstract
10: Lo IK, Kirkley A, Fowler PJ, Miniaci A. Related Articles, Links
The outcome of operatively treated anterior cruciate ligament
disruptions in the skeletally immature child.
Arthroscopy. 1997 Oct;13(5):627-34.
PMID: 9343653 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9343653&dopt=Abstract
11: Matava MJ, Siegel MG. Related Articles, Links
Arthroscopic reconstruction of the ACL with semitendinosus-gracilis
autograft in skeletally immature adolescent patients.
Am J Knee Surg. 1997 Spring;10(2):60-9.
PMID: 9131235 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9131235&dopt=Abstract
12: Scherping SC Jr, Schmidt CC, Georgescu HI, Kwoh CK, Evans CH, Woo
SL. Related Articles, Links
Effect of growth factors on the proliferation of ligament fibroblasts
from skeletally mature rabbits.
Connect Tissue Res. 1997;36(1):1-8.
PMID: 9298619 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9298619&dopt=Abstract
13: Janarv PM, Nystrom A, Werner S, Hirsch G. Related Articles,
Links
Anterior cruciate ligament injuries in skeletally immature patients.
J Pediatr Orthop. 1996 Sep-Oct;16(5):673-7.
PMID: 8865058 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8865058&dopt=Abstract
14: Shelbourne KD, Patel DV, McCarroll JR. Related Articles, Links
Management of anterior cruciate ligament injuries in skeletally
immature adolescents.
Knee Surg Sports Traumatol Arthrosc. 1996;4(2):68-74.
PMID: 8884725 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8884725&dopt=Abstract
15: Mizuta H, Kubota K, Shiraishi M, Otsuka Y, Nagamoto N, Takagi K.
Related Articles, Links
The conservative treatment of complete tears of the anterior cruciate
ligament in skeletally immature patients.
J Bone Joint Surg Br. 1995 Nov;77(6):890-4.
PMID: 7593101 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7593101&dopt=Abstract
16: McCarroll JR, Shelbourne KD, Patel DV. Related Articles, Links
Anterior cruciate ligament injuries in young athletes. Recommendations
for treatment and rehabilitation.
Sports Med. 1995 Aug;20(2):117-27. Review.
PMID: 7481281 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7481281&dopt=Abstract
17: Stanitski CL. Related Articles, Links
Anterior Cruciate Ligament Injury in the Skeletally Immature Patient:
Diagnosis and Treatment.
J Am Acad Orthop Surg. 1995 May;3(3):146-158.
PMID: 10790663 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10790663&dopt=Abstract
18: Guzzanti V, Falciglia F, Gigante A, Fabbriciani C. Related
Articles, Links
The effect of intra-articular ACL reconstruction on the growth plates
of rabbits.
J Bone Joint Surg Br. 1994 Nov;76(6):960-3.
PMID: 7983128 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7983128&dopt=Abstract
19: Nottage WM, Matsuura PA. Related Articles, Links
Management of complete traumatic anterior cruciate ligament tears in
the skeletally immature patient: current concepts and review of the
literature.
Arthroscopy. 1994 Oct;10(5):569-73. Review.
PMID: 7999169 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7999169&dopt=Abstract
20: Wester W, Canale ST, Dutkowsky JP, Warner WC, Beaty JH. Related
Articles, Links
Prediction of angular deformity and leg-length discrepancy after
anterior cruciate ligament reconstruction in skeletally immature
patients.
J Pediatr Orthop. 1994 Jul-Aug;14(4):516-21.
PMID: 8077439 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8077439&dopt=Abstract
21: Stanitski CL. Related Articles, Links
Surgical reconstruction for symptomatic ACL insufficiency in
skeletally immature athletes.
Am J Sports Med. 1994 May-Jun;22(3):433. No abstract available.
PMID: 8037288 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8037288&dopt=Abstract
22: Schaefer RA, Eilert RE, Gillogly SD. Related Articles, Links
Disruption of the anterior cruciate ligament in a 4-year-old child.
Orthop Rev. 1993 Jun;22(6):725-7.
PMID: 8351176 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8351176&dopt=Abstract
23: Graf BK, Lange RH, Fujisaki CK, Landry GL, Saluja RK. Related
Articles, Links
Anterior cruciate ligament tears in skeletally immature patients:
meniscal pathology at presentation and after attempted conservative
treatment.
Arthroscopy. 1992;8(2):229-33.
PMID: 1637437 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1637437&dopt=Abstract
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