Anterior Cruciate Ligament Injuries in the Skeletally Immature Athlete…: Journal of AAOS(February 2013)

Written by admin on March 4, 2013 – 6:19 am -

Anterior Cruciate Ligament Injuries in the Skeletally Immature Athlete: Diagnosis and Management

Jeremy S. Frank, MD and Peter L. Gambacorta, DO

Abstract

Intrasubstance anterior cruciate ligament (ACL) injuries in children and adolescents were once considered rare occurrences, with tibial eminence avulsion fractures generally regarded as the pediatric ACL injury equivalent. However, with increased single-sport focus, less free play, and year-round training at younger ages, intrasubstance ACL injuries in children and adolescents are being diagnosed with increased frequency. As in the adult, a knee devoid of ligamentous stability predisposes the pediatric patient to meniscal and chondral injuries and early degenerative changes.

Management of ACL injuries in skeletally immature patients includes physeal-sparing, partial transphyseal, and complete transphyseal ACL reconstruction. Complications include iatrogenic growth disturbance resulting from physeal violation.

In the past 20 years, sports injuries in pediatric and adolescent athletes have dramatically increased. Approximately 38 million young athletes participate in organized sports annually in the United States. Of these, nearly 2 million high school students and almost twice as many athletes aged <14 years are treated for a sports-related injury each year. This new epidemic of sports-related injuries can be partially attributed to the dramatic surge in the number of participants since the passage of Title IX, along with increased emphasis on year-round competition, single-sport concentration, and more intense training.

Summary

ACL ruptures in skeletally immature patients are becoming more common with increased single-sport concentration, year-round participation, and less time spent in free play. It is the role of pediatric sports medicine providers to properly diagnose and manage these injuries. Nonsurgical management, including activity modification, bracing, and physical therapy, is best used for patients with partial tears involving <50% of the ACL diameter. In patients with complete ruptures, chronologic, physiologic, and skeletal maturity must be assessed to appropriately address the injury. Treatment options are predicated on assessment of the patient’s maturity and include physeal-sparing, partial and complete transphyseal, and adult-type anatomic ACL reconstruction. Postoperative management includes weight-bearing and activity modifications, bracing, and a progressive physical therapy protocol emphasizing ROM, closed-chain strengthening, and a gradual and measured return to sport-specific maneuvers. Surgical complications are rare.

Journal AAOS © 2013 (February)


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Study: Autograft ACL repair better in young athletes

Written by admin on February 25, 2013 – 3:45 pm -

(FoxNews: May 3, 2012)

A new study suggests young athletes who need knee ligament surgery do better over the long run when their own tissue is used for the reconstruction procedure, rather than tissue from a donor.

The anterior cruciate ligament (ACL) connects the upper and lower leg bones and helps stabilize the knee. It gets the most use in athletes who play a sport such as basketball that involves quick cuts and changes in direction.

Those athletes are also the most likely to suffer a torn ACL — the same injury that took down Chicago Bulls player Derrick Rose in the first round of the National Basketball Association playoffs last weekend.

The new findings support past research suggesting that when those injuries occur, it’s better to use a person’s own tissue to repair their ACL — also known as an autograft, said Dr. Cassandra Lee, a sports medicine doctor at the University of California, Davis, who wasn’t involved in the new study.

Typically, the tissue for an autograft is taken from a person’s hamstring or patellar tendon. The alternative — an allograft — is donated tissue from a cadaver.

For the new study, researchers at the United States Military Academy in West Point, New York tracked members of their 2007 through 2013 classes who had ACL reconstruction before entering the Academy. The students ranged from 18 to 23 years old.

Dr. Brett Owens, the study’s senior investigator and chief of orthopedic surgery service at Keller Army Hospital in West Point, told Reuters Health the researchers started their study after noticing an increase in the number of reconstructions using donated tissue that had failed.

They identified 120 cadets who’d had a total of 122 ACL reconstructions. Of those, 106 had their ACLs reconstructed with autografts; the rest had donor tissue.

Since all cadets receive medical care at the Academy, the researchers knew 20 of the ACL reconstructions failed — meaning cadets had to have the surgery re-done. Those failures happened an average of a year and a half after students started at the Academy.

Of the reconstructions that failed, 13 were from surgeries using the cadets’ own tissue — about 12 percent of all autografts — and seven were from cadavers, accounting for 44 percent of reconstructions that used donated tissue.

The researchers reported that cadets who had ACL allograft reconstruction were almost seven times as likely to need a second surgery compared to when cadets’ own tissue had been used.

Owens and his colleagues also reported that ACL allograft reconstructions failed much earlier, on average, than autografts.

They wrote in the American Journal of Sports Medicine that they recommend the use of autografts in young athletes.

There are about 150,000 ACL injuries every year in the U.S., according to the American Orthopaedic Society for Sports Medicine. The cost of reconstruction surgery varies, but typically runs between $5,000 and $7,000.

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