Arthroscopic anterior cruciate ligament repair for proximal anterior cruciate ligament tears in skeletally immature patients: Surgical technique and preliminary results.
BACKGROUND
Anterior cruciate ligament (ACL) tears in children are increasingly common and present difficult treatment decisions due to the risk of growth disturbance. Although open primary ACL repair was abandoned in the historical literature, recent studies have suggested that there is a role for arthroscopic primary repair in patients with proximal tears.


METHODS
This is a retrospective review of five consecutive patients aged 9.2years (range 8 to 10) who underwent suture anchor ACL reinsertion. Patients were included if they were Tanner stages 1-2 and proximal ACL tears with adequate tissue quality confirmed arthroscopically. The time frame was 81days. Arthroscopic ACL reinsertion was performed with bioabsorbable suture anchor. Clinical evaluation, KT-1000™, and MRI were re-evaluated. Clinical outcomes were measured using International Knee Documentation Committee (IKDC), Lysholm and Tegner activity score.


RESULTS
At a mean follow-up of 43.4months (range 25 to 56), no re-injury and leg length discrepancies were observed. Four patients had negative Lachman tests. The remainder had a grade 1 Lachman test. The mean side-to-side difference was 3 (2-4mm). In MRI obtained at the last follow-up, no articular lesions or growth arrest were observed and the reinserted ACL was recognized in every exam. All patients returned to previous level of activity and presented normal and nearly normal IKDC score. The mean Lysholm score was 93.6.


CONCLUSIONS
Arthroscopic ACL repair can achieve good short-term results with joint stability and recovery of sport activity in skeletally immature patients, with proximal ACL avulsion tear.
Orthopedic Department, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy.
Marco
M
Bigoni
Orthopedic Department, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy.
Diego
D
Gaddi
Orthopedic Department, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy.
Massimo
M
Gorla
Orthopedic Department, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy.
Daniele
D
Munegato
Orthopedic Department, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy.
Marco
M
Pungitore
Orthopedic Department, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy.
Massimiliano
M
Piatti
Orthopedic Department, San Gerardo Hospital, Via Pergolesi 33, 20900 Monza, Italy. Electronic address: turati.mrc@gmail.com.
Marco
M
Turati
D000367:Age Factors; D000070598:Anterior Cruciate Ligament Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001182:Arthroscopy / Q000379:methods*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D053441:Suture Anchors; D016896:Treatment Outcome
Anterior cruciate ligament; Arthroscopic fixation; Open physes; Pediatric; Sport injury