The current evidence for treatment of ACL injuries in children is low: a systematic review.
BACKGROUND
There is no consensus on the management of anterior cruciate ligament (ACL) injuries in skeletally immature children, and the methodological quality of published studies is questionable. The transphyseal reconstructions, physeal-sparing reconstructions, and nonoperative treatment algorithms that are advocated have little support in the literature. The purpose of this study was to systematically review the methodological quality of the literature on the management of ACL injuries in skeletally immature children.


METHODS
We performed a literature search with use of PubMed to identify prospective or retrospective studies whose primary aim was to assess the outcome after operative or nonoperative treatment of ACL injuries in skeletally immature children. To be included in the analysis, a study had to have a mean duration of follow-up of at least two years and a minimum of ten children in the study had to be verified to be skeletally immature. The methodological quality of the included studies was evaluated with use of the Coleman Methodology Score.


RESULTS
No randomized controlled trials, two prospective cohort studies, and twenty-nine retrospective studies met the inclusion criteria. The Coleman Methodology Score averaged 44.7 ± 9.2 out of 100 (range, 28 to 62). The methodological deficiencies were most evident with regard to the number of included children, the study design, and the description of rehabilitation protocols, outcome criteria, and outcome assessments.


CONCLUSIONS
Caution is necessary when interpreting the results of studies on the treatment of ACL injuries in skeletally immature children because of widespread methodological deficiencies. There is a need for appropriately sized prospective studies and detailed descriptions of rehabilitation programs.
Norwegian Research Centre for Active Rehabilitation, Department of Sports Medicine, Norwegian School of Sport Sciences, PB 4014 Ullevål Stadion, 0806 Oslo, Norway. havard.moksnes@nih.no
Håvard
H
Moksnes
Lars
L
Engebretsen
May Arna
MA
Risberg
D000367:Age Factors; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D002648:Child; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation* / Q000601:surgery*