The functional outcome of total tears of the anterior cruciate ligament (ACL) in the skeletally immature patient

摘要

Tears of the anterior cruciate ligament (ACL) in the skeletally immature patient are becoming more prevalent. The aim of this study was to describe the functional outcome and to evaluate the best management of total tears of the ACL in skeletally immature patient. Twenty consecutive, skeletally immature patients with a clinically evident rupture of the anterior cruciate ligament were followed up for a mean of 5.4 years. The mean age at the time of injury was 13.9 years old. The study group consisted of 13 girls and 7 boys, who were treated either conservatively, by ACL reconstruction, by primary repair or by delayed ACL reconstruction after skeletal maturity had been reached. Clinical outcomes were measured using the International Knee Documentation Committee Scoring System (IKDC) and the Knee Injury and Osteoarthritis Outcome Scoring System (KOOS). The radiological evaluation was performed using Jaeger and Wirth's criteria, and instrumented laxity testing was carried out with a Rolimeter. Five of the eight patients treated conservatively showed poor function of the knee, and this resulted in instability. Concerning the patients treated by primary repair, delayed ACL reconstruction or arthroscopic debridement, we also found none of the results to be satisfactory (seven of eight patients). The patients that were treated by a reconstruction had the best results. This was confirmed by clinical examination (Lachmann grade 1), by the IKDC (grade B) and by the KOOS with the best quality of life and no giving-way attacks. The level of evidence was therapeutic level III.