Abstract
Anterior cruciate ligament (ACL) injuries in skeletally immature adolescents are bein diagnosed and reported with increasing frequency. Nonoperative management of midsubstance ACL injuries in adolescent athletes frequently results in a high incidence of giving-way episodes, recurrent meniscal tears, and early onset of osteoarthritis. An intraarticular ACL reconstruction (using the central 10-mm patellar tendon graft) in young athletes approaching skeletal maturity provides predictable excellent knee stability, and the athletes are able to return to competitive sports with a decreased risk of recurrent meniscal and/or chondral injury. Guidelines for the management of ACL injuries in skeletally immature adolescents are presented.
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Andrews M, Noyes FR, Barber-Westin SD (1994) Anterior cruciate ligament allograft reconstruction in the skeletally immature athlete. Am J Sports Med 22: 48–54
Angel KR, Hall DJ (1989) Anterior cruciate ligament injury in children and adolescents. Arthroscopy 5: 197–200
Blitzer CM, Johnson RJ, Ettlinger CF, Aggeborn K (1984) Downhill skiing injuries in children. Am J Sports Med 12: 142–147
Bradley GW, Shives TC, Samuelson KM (1979) Ligament injuries in the knees of children. J Bone Joint Surg [Am] 61: 588–591
Brief LP (1991) Anterior cruciate ligament reconstruction without drill holes. Arthroscopy 7: 350–357
Clanton TO, DeLee JC, Sanders B, Neidre A (1979) Knee ligament injuries in children. J Bone Joint Surg [Am] 61: 1195–1201
DeLee JC (1988) ACL insufficiency in children. In: Feagin JA Jr (ed) The crucial ligaments, Churchill Livingstone. New York, pp 439–447
DeLee JC (1994) ACL insufficiency in children. In: Feagin JA Jr (ed) The crucial ligaments, 2nd edn Churchill Livingstone, New York, pp 649–676
DeLee JC, Curtis R (1983) Anterior cruciate ligament insufficiency in children. Clin Orthop 172: 112–118
Engebretsen L, Svenningsen S, Benum P (1988) Poor results of anterior cruciate ligament repair in adolescence. Acta Orthop Scand 59: 684–686
Feagin JA Jr, Curl WW (1976) Isolated tear of the anterior cruciate ligament: five-year follow-up study. Am J Sports Med 4: 95–100
FitzGibbons RE, Shelbourne KD (1995) Aggressive nontreatment of lateral meniscal tears seen during anterior cruciate ligament reconstruction. Am J Sports Med 23: 156–159
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
Kannus P, Järvinen M (1988) Knee ligament injuries in adolescents: eight year follow-up of conservative management. J Bone Joint Surg [Br] 70: 772–776
Lipscomb AB, Anderson AF (1986) Tears of the anterior cruciate ligament in adolescents. J Bone Joint Surg [Am] 68: 19–28
Matz SO, Jackson DW (1988) Anterior cruciate ligament injury in children. Am J Knee Surg 1: 59–65
McCarroll JR, Rettig AC, Shelbourne KD (1988) Amerior cruciate ligament injuries in the young athlete with open physes. Am J Sports Med 16: 44–47
McCarroll JR, Shelbourne KD, Porter DA, Rettig AC, Murray S (1994) Patellar tendon graft reconstruction for midsubstance anterior cruciate ligament rupture in junior high school athletes: an algorithm for management. Am J Sports Med 22: 478–484
McCarroll JR, Shelbourne KD, Patel DV (1995) Anterior cruciate ligament injuries in young athletes: recommendations for treatment and rehabilitation Sports Med 20: 117–127
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: 890–894
Noyes FR, Matthews DS, Mooar PA, Grood ES (1983) The symptomatic anterior cruciate-deficient knee. Part II. The results of rehabilitation, activity modification, and counseling on functional disability. J Bone Joint Surg [Am] 65: 163–174
Parker AW, Drez D Jr, Cooper JL (1994) Anterior cruciate ligament injuries in patients with open physes. Am J Sports Med 22: 44–47
Patel DV, Aichroth PM, Al-Duri ZA (1993) The natural history of anterior cruciate ligament injuries in children and adolescents. J Bone Joint Surg [Br] 75 [Suppl I]: 31–32
Pattee GA, Fox JM, Del Pizzo W, Friedman MJ (1989) Four to ten year follow-up of unrecostructed anterior cruciate ligament tears. Am J Sports Med 17: 430–435
Scammell BE, Robertson JA (1990) Insubstance tears of the anterior cruciate in the growing child. J Bone Joint Surg [Br] 72: 167
Shelbourne KD, Martini DJ, McCarroll JR, Van Meter CD (1995) Correlation of joint line tenderness and meniscal lesions in patients with acute anterior cruciate ligament tears. Am J Sports Med 23: 166–169
Skak SV, Jensen TT, Poulsen TD, Sturup J (1987) Epidemiology of knee injuries in children. Acta Orthop Scand 58: 78–81
Stanitski CL (1995) Anterior cruciate ligament injury in the skeletally immature patient: diagnosis and treatment. J Am Acad Orthop Surg 3: 146–158
Steiner ME, Grana WA (1988) The young athlete's knee: recent advances. Clin Sports Med 7: 527–546
Sullivan JA (1990) Ligamentous injuries of the knee in children. Clin Orthop 255: 44–50
Tanner JM (1962) The development of the reproductive system. In: Tanner JM (ed) Growth at adolescence, 2nd edn. Blackwell Scientific, Oxford, pp. 28–39
Warren RF, Levy IM (1983) Meniscal lesions associated with anterior cruciate ligament injury. Clin Orthop 172: 32–37
Whipple TL, Poehling GG (1987) Concurrent injuries of the anterior cruciate ligament and the menisci of the knee. Am J Sports Med 15: 388–389
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Shelbourne, K.D., Patel, D.V. & McCarroll, J.R. Management of anterior cruciate ligament injuries in skeletally immature adolescents. Knee Surg, Sports traumatol, Arthroscopy 4, 68–74 (1996). https://doi.org/10.1007/BF01477256
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DOI: https://doi.org/10.1007/BF01477256