The management of anterior cruciate ligament (ACL) injuries in the skeletally immature patient is an area of controversy. The purpose of this survey is to inventory the current state of care for pediatric ACL injuries in the Netherlands. This survey was conveyed by e-mail among all members of the Dutch Arthroscopy Society (Nederlandse Vereniging van Arthroscopie [NVA]) and promoted on the Web site of the NVA. It was developed by the scientific committee of the NVA by a consensus meeting discussing relevant topics in pediatric ACL injuries. All members of the NVA received the survey ( = 540). A total of 158 (29%) members responded to the survey, of which 143 were completed. A total of 126 responses were analyzed after exclusion. The main finding of this survey is that 78% of the respondents tend to treat children with open physes nonoperatively, while 65% tend to treat children with closed physes operatively. The most frequently performed procedure is the transphyseal reconstruction. Many considerations were involved in choosing operative treatment. The postoperative follow-up period varies from less than 1 year (24%) until fully grown (27%). In conclusion, this survey shows that the current state of care for pediatric ACL injuries is variable and a matter of debate in the Netherlands. Although the response rate seems low, this survey provides an overview of the opinions of specialized orthopaedic surgeons in the Netherlands. The results of this survey led to the development of the national registry for pediatric ACL in the Netherlands. The level of evidence for this study is V.
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http://dx.doi.org/10.1055/s-0039-1697626 | DOI Listing |
Am J Sports Med
January 2025
Musculoskeletal Institute, Atrium Health Carolinas Medical Center; Orthopaedic Surgery, Wake Forest University School of Medicine; and OrthoCarolina, Charlotte, North Carolina, USA.
Background: Loss of motion and arthrofibrosis after anterior cruciate ligament (ACL) reconstruction (ACLR) can be devastating complications for athletes. The cellular and molecular pathogenesis of arthrofibrosis is poorly understood, limiting prevention and treatment options. Synovial inflammation may contribute to post-ACLR arthrofibrosis.
View Article and Find Full Text PDFJ Clin Med
December 2024
Department of Orthopedics, Akron Children's Hospital, Akron, OH 44307, USA.
The management of anterior cruciate ligament (ACL) injuries in pediatric patients presents unique challenges due to the presence of open growth plates in the proximal tibia and distal femur. Delaying ACL reconstruction until skeletal maturity may protect the physes but increases the risk of secondary injuries, such as meniscal tears and chondral damage, due to prolonged joint instability. Conversely, early surgical intervention restores knee stability but raises concerns about potential growth disturbances, including leg-length discrepancies and angular deformities.
View Article and Find Full Text PDFJ Pers Med
November 2024
Center for Diagnostic and Interventional Radiology and Nuclear Medicine, Charité-University Medicine Berlin, 10117 Berlin, Germany.
There remains considerable debate regarding the optimal management of anterior cruciate ligament (ACL) injuries in skeletally immature patients. This study aims to evaluate the clinical outcomes of transphyseal ACL reconstruction in patients with open growth plates. This retrospective study included skeletally immature patients with full-thickness ACL tears and confirmed open physis.
View Article and Find Full Text PDFProc (Bayl Univ Med Cent)
September 2024
Texas A&M University, Temple, Texas, USA.
A 13-year-old boy was referred to orthopedic surgery for chronic intermittent pain and swelling of the left knee. Initial imaging was consistent with osteochondritis dissecans of the femoral condyle. Follow-up imaging demonstrated unexpected progression, with a mass extending into the notch, replacing the anterior cruciate ligament, and eroding the femoral and tibial condyles.
View Article and Find Full Text PDFOrthop J Sports Med
December 2024
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Background: Postoperative knee arthrofibrosis after arthroscopic ligament reconstruction is a serious complication. Among adolescents, risk factors for postoperative arthrofibrosis are not well characterized and the effectiveness of early manipulation under anesthesia (MUA) is not well established.
Purposes: To identify risk factors for arthrofibrosis after arthroscopic knee ligament reconstruction in adolescent patients and to evaluate the safety and effectiveness of early MUA.
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