Summary

This study included 16 patients with open physis, who underwent ACL reconstruction and began conservative treatment early by ACL specialists were classified as the Expert group, while by non-ACL specialists were classified as the Standard group. The rate of medial meniscus damage was significantly higher in the S group.

Abstract

Purpose

The treatment of pediatric and adolescent anterior cruciate ligament (ACL) injuries requires a different approach from adults due to their skeletal maturity. Several studies have recommended early ACL reconstruction in patients with open physis in order to reduce the risk of meniscus and cartilage injuries when returning to sport. In contrast, other studies have suggested conservative treatment and delaying reconstruction until skeletal maturity to prevent potential growth disturbances caused by surgery, making the management of ACL injuries in patients with open physis a highly controversial topic. The aim of this study was to investigate the effect of different conservative treatments on the risk of occurring meniscus and cartilage damage in cases of ACL injuries in adolescent patients with open physis.

Materials And Methods

This study included 16 patients with open physis, each requiring more than six months to closure physis, who underwent ACL reconstruction. There were 11 males and five females, with an average age of 12.3 years at the time of injury. Of the 16 patients, those who began conservative treatment early after injury by our hospital's ACL specialists were classified as the Expert group (E group; n=10), while those referred to our hospital at least 3 months after injury by non-ACL specialists were classified as the Standard group (S group; n=6). Clinical evaluations involved measuring the side-to-side difference of anterior tibial translation (ATT) using KS Measure KSM-100® (Nippon Sigmax Co.,Ltd., Tokyo, Japan), peak isokinetic (60°/s) and isometric (80° of flexion) torque of the quadriceps and hamstrings, the Tegner activity scale (TAS), the International Knee Documentation Committee (IKDC) subjective score, and the average number of giving way (GW) episodes. Meniscal and cartilage damage were evaluated during surgery.

Results

There were no significant differences between the two groups in time to surgery (P = 0.63), ATT (P = 0.48), TAS (P = 0.33), mean peak isokinetic torque (quadriceps: P = 0.13, hamstrings: P = 0.70), isometric torque (quadriceps: P = 0.12, hamstrings: P = 0.75). The mean IKDC subjective score was 85.7 ± 3.7 in the E group and 78.2 ± 5.6 in the S group (P < 0.01), with GW episodes averaging 1.6 in the E group and 3.8 in the S group, which showed significantly more episodes in the S group (P = 0.01). The rate of medial meniscus damage was 20% in the E group and 83% in the S group, significantly higher in the S group (P = 0.01). Lateral meniscus (P = 1.00) and cartilage damage (P = 0.25) were comparable between the two groups. During the preoperative waiting period for ACL reconstruction, only one case in the E group required lateral meniscal repair due to symptoms of meniscus injury.

Conclusion

The rate of meniscus and cartilage injuries after ACL injury has been reported to increase with the lengthening of the preoperative waiting period. However, our results suggest that it is more closely related to appropriate earlier conservative treatment, thorough optimal education, and activity restriction for the affected patients, including their parents.