Partial tears of the anterior cruciate ligament in children and adolescents.
BACKGROUND
The functional outcome after partial anterior cruciate ligament tears in children and adolescents treated without reconstruction has not been established.


OBJECTIVE
Nonreconstructive management of partial anterior cruciate ligament tears can be effective in certain pediatric patients.


METHODS
Prospective cohort study.


METHODS
We studied 45 skeletally mature and immature patients 17 years of age or less who had an acute hemarthrosis, magnetic resonance imaging signal changes, grade A or B Lachman and pivot shift result, and an arthroscopically documented partial anterior cruciate ligament tears. All patients were treated without reconstruction, underwent a structured rehabilitation program, and were followed up for a minimum of 2 years.


RESULTS
Fourteen patients (31%) underwent subsequent reconstruction. Significant associations with subsequent reconstruction included tears that were greater than 50%, predominantly posterolateral tears, a grade B pivot shift test result, and older chronologic and skeletal age. Among patients who did not require reconstruction, those with tears that were greater than 50% or predominantly posterolateral had significantly lower Lysholm, satisfaction, and Cincinnati Knee Scale scores.


CONCLUSIONS
Nonreconstructive management is recommended for partial anterior cruciate ligament tears in children and adolescents 14 years of skeletal age or younger with normal or near-normal Lachman and pivot shift results. Reconstruction is recommended in older athletes or in those with greater than 50% or predominantly posterolateral tears.
Kocher
Mininder S
MS
Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Micheli
Lyle J
LJ
Zurakowski
David
D
Luke
Anthony
A
D000293:Adolescent; D000704:Analysis of Variance; D000070598:Anterior Cruciate Ligament Injuries; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation* / Q000601:surgery; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012421:Rupture / Q000534:rehabilitation / Q000601:surgery; D016896:Treatment Outcome