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The Journal of Sports Medicine and Physical Fitness 2021 Oct 05

DOI: 10.23736/S0022-4707.21.12783-5


language: English

Management of anterior cruciate ligament tears in Tanner stage 1 and 2 children: a narrative review and treatment algorithm guided by ACL tear location

Marco TURATI 1, 2, 3, 4 , Luca RIGAMONTI 1, 3, 5, Andrea GIULIVI 1, 3, Diego GADDI 2, 3, Franck ACCADBLED 7, Nicolò ZANCHI 1, 3, Nicolas BREMOND3 , 4, Marcello CATALANO 1, 3, Massimo GORLA 2, 3, Robert J. OMELJANIUK 6, Giovanni ZATTI 1, 2, 3, Massimiliano PIATTI 2 ,3, Marco BIGONI 1, 2, 3

1 School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; 2 Orthopedic Department, San Gerardo Hospital, Monza, Italy; 3 Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; 4 Department of Paediatric Orthopaedic Surgery, Hospital Couple Enfant, Grenoble Alpes University, Grenoble, France; 5 Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; 6 Department of Biology, Lakehead University, Thunder Bay, ON, Canada; 7 Department of Orthopaedics, Children's Hospital, CHU de Toulouse, Toulouse, France


INTRODUCTION: The incidence of anterior cruciate ligament (ACL) tears in skeletally immature patients has acutely increased over the last 20 years, yet there is no consensus on a single “best treatment”. Selection of an optimal treatment is critical and based on individual circumstances; consequently, we propose a treatment-selection algorithm based on (i) skeletal development, (ii) ACL tear location, type, and quality, as well as (iii) parental perspective in order to facilitate the decision-making process.
EVIDENCE ACQUISITION: We combined our surgical group's extensive case histories of ACL tear management in Tanner Stage 1 and 2 patients with those in the literature to form a consolidated data base. For each case (i) the diagnostic phase, (ii) communication with patient and parents, (iii) treatment choice(s), (iv) selected surgical techniques and (v) rehabilitation schedule were critically analyzed and compared for patient outcomes.
EVIDENCE SYNTHESIS: MRI-imaging and intraoperative tissue quality assessment were preeminent in importance for selection of the optimal treatment strategy. Considerations for selecting an optimal treatment included: (i) associated lesions, (ii) the child/patient and parent(s)’ well-informed and counseled consent, (iii) biological potential, and (iv) the potential for successful ACL preservative surgery. Complete ACL tears were evaluated according to tear-location. In Type I and II ACL tears with remaining good tissue quality, we propose primary ACL repair. In Type III and IV ACL tears we propose physeal-sparing reconstruction with an iliotibial band graft. Finally, in the case of a Type V ACL tear, we propose that the best treatment be based on the Meyers-McKeever classification.
CONCLUSIONS: We present a facile decision-making algorithm for ACL management in pediatric patients based on specific elements of tissue damage and status.

KEY WORDS: Pediatric; Anterior cruciate ligament; Algorithm; Repair

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