Patrick Vavken1, Martha M Murray. 1. Sports Medicine Research Laboratory, Department of Orthopedic Surgery, Children's Hospital Boston, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA. patrick.vavken@childrens.harvard.edu
Abstract
PURPOSE: To systematically review the current evidence for conservative and surgical treatment of anterior cruciate ligament (ACL) tears in skeletally immature patients. METHODS: A systematic search of PubMed, CINAHL, EMBASE, CCTR, and CDSR was performed for surgical and/or conservative treatment of complete ACL tears in immature individuals. Studies with less than six months of follow-up were excluded. Study quality was assessed and data were collected on clinical outcome, growth disturbance, and secondary joint damage. RESULTS: We identified 48 studies meeting the inclusion criteria. Conservative treatment was found to result in poor clinical outcomes and a high incidence of secondary defects, including meniscal and cartilage injury. Surgical treatment had only very weak evidence for growth disturbance, yet strong evidence of good postoperative stability and function. No specific surgical treatment showed clearly superior outcomes, yet the studies using physeal-sparing techniques had no reported growth disturbances at all. CONCLUSIONS: The current best evidence suggests that surgical stabilization should be considered the preferred treatment in immature patients with complete ACL tears. While physeal-sparing techniques are not associated with a risk of growth disturbance, transphyseal reconstruction is an alternative with a beneficial safety profile and a minimal risk of growth disturbance. Conservative treatment commonly leads to meniscal damage and cartilage destruction and should be considered a last resort. LEVEL OF EVIDENCE: Level IV, systematic review of Level II, III, and IV studies.
PURPOSE: To systematically review the current evidence for conservative and surgical treatment of anterior cruciate ligament (ACL) tears in skeletally immature patients. METHODS: A systematic search of PubMed, CINAHL, EMBASE, CCTR, and CDSR was performed for surgical and/or conservative treatment of complete ACL tears in immature individuals. Studies with less than six months of follow-up were excluded. Study quality was assessed and data were collected on clinical outcome, growth disturbance, and secondary joint damage. RESULTS: We identified 48 studies meeting the inclusion criteria. Conservative treatment was found to result in poor clinical outcomes and a high incidence of secondary defects, including meniscal and cartilage injury. Surgical treatment had only very weak evidence for growth disturbance, yet strong evidence of good postoperative stability and function. No specific surgical treatment showed clearly superior outcomes, yet the studies using physeal-sparing techniques had no reported growth disturbances at all. CONCLUSIONS: The current best evidence suggests that surgical stabilization should be considered the preferred treatment in immature patients with complete ACL tears. While physeal-sparing techniques are not associated with a risk of growth disturbance, transphyseal reconstruction is an alternative with a beneficial safety profile and a minimal risk of growth disturbance. Conservative treatment commonly leads to meniscal damage and cartilage destruction and should be considered a last resort. LEVEL OF EVIDENCE: Level IV, systematic review of Level II, III, and IV studies.
Authors: Rupert Meller; Daniel Kendoff; Stefan Hankemeier; Michael Jagodzinski; Martin Grotz; Karsten Knobloch; Christian Krettek Journal: Am J Sports Med Date: 2008-09-24 Impact factor: 6.202
Authors: Alessandro Liberati; Douglas G Altman; Jennifer Tetzlaff; Cynthia Mulrow; Peter C Gøtzsche; John P A Ioannidis; Mike Clarke; P J Devereaux; Jos Kleijnen; David Moher Journal: PLoS Med Date: 2009-07-21 Impact factor: 11.069
Authors: Patrick Vavken; Braden C Fleming; Ashley N Mastrangelo; Jason T Machan; Martha M Murray Journal: Arthroscopy Date: 2012-01-20 Impact factor: 4.772
Authors: Patrick Vavken; Benedikt Proffen; Chris Peterson; Braden C Fleming; Jason T Machan; Martha M Murray Journal: Arthroscopy Date: 2012-11-30 Impact factor: 4.772