From the Research
Treatment Options for Anterior Cruciate Ligament (ACL) Injuries in Pediatric Patients
- The treatment options for pediatric and adolescent anterior cruciate ligament (ACL) injuries include early operative, delayed operative, and nonoperative management 1.
- A systematic review and meta-analysis found that early ACL reconstruction results in fewer meniscal tears than delayed reconstruction, but yields no difference in knee stability 1.
- Nonoperative management resulted in high rates of residual knee instability, increased risk of meniscal tears, and comparatively low rates of return to sports 1, 2.
- A meta-analysis found that nonoperative or delayed-operative patients were 33.7 times more likely to report instability than the early operative group 2.
- Early operative treatment is initiated shortly after the injury, while the patient is still skeletally immature and the growth plates are open, and may result in less knee instability and a more likely return to the preinjury activity level without affecting the growth plates or causing growth disturbances 2.
- Active rehabilitation may have a role in treatment of children with ACL injury, and approximately 50% of children may cope well, even to adulthood, without a surgical intervention 3.
- Conservative management of ACL rupture in pediatric population is a valuable treatment which permits return to a normal life with sports activities without major increasing of meniscal tears, but clinical instability at first examination was the only significant predictive factors of bad tolerance of conservative management 4.
Comparison of Treatment Options
- Early operative treatment versus delayed operative treatment: early ACL reconstruction results in fewer meniscal tears than delayed reconstruction 1.
- Operative treatment versus nonoperative treatment: operative treatment results in fewer meniscal tears, greater knee stability, and higher return-to-sport rates than nonoperative treatment 1, 2.
- Conservative management versus surgical intervention: conservative management is a valuable treatment option for pediatric patients with ACL injuries, but may not be suitable for all patients, especially those with clinical instability at first examination 3, 4.
Factors Influencing Treatment Outcomes
- Age and skeletal maturity: the treatment approach may vary depending on the patient's age and skeletal maturity 5.
- Presence of meniscal tears: meniscal tears are a common complication of ACL injuries, and the treatment approach may depend on the presence and severity of meniscal tears 1, 2, 4.
- Clinical instability: clinical instability at first examination is a significant predictive factor of bad tolerance of conservative management 4.