Moksnes Håvard, Engebretsen Lars, Risberg May Arna
The Norwegian Sport Medicine Clinic and Norwegian School of Sport Sciences, NAR, Orthopaedic Centre, Ullevaal University Hospital, NIMI Ullevaal, Sognsveien 75 D, 0805 Oslo, Norway.
Knee Surg Sports Traumatol Arthrosc. 2008 Mar;16(3):214-23. doi: 10.1007/s00167-007-0469-7. Epub 2007 Dec 22.
There is limited scientific knowledge on ACL injuries in children 12 years or younger. Substantial controversy exists on treatment algorithms and there are no published data on performance-based functional outcome. Classification of adult ACL injured subjects as copers and non-copers is common, but no study has classified knee function in children using performance-based functional test after ACL injury. The aim of the present study was to evaluate the medium-term functional outcome among children with ACL injury and to classify them as copers and non-copers. Children 12 years or younger who were referred to our institution from 1996 to 2004 with an ACL injury were included. Twenty non-operated subjects (21 knees) and six ACL reconstructed subjects (7 knees) were examined at a minimum of 2 years after ACL injury or reconstruction. Four single-legged hop tests, isokinetic muscle strength measurements, and three functional questionnaires (IKDC 2000, KOS-ADLS and Lysholm) were used as outcome measurements. Children who had resumed their pre-injury activity level and performed above 90% on all hop tests were classified as copers following non-operative treatment and ACL reconstruction. The 26 children were on average 10.1 years at the time of injury. Of the non-operated children, 65% had returned to pre-injury activity level, and 50% were classified as copers. Copers scored significantly better than non-copers on single hop for distance, IKDC 2000, and Lysholm score. Of the non-operated children, 9.5% had suffered a secondary meniscus injury. Of the ACL reconstructed subjects, 67% were classified as copers at follow-up. Non-operated ACL-deficient children demonstrated excellent knee function on performance-based single-legged hop tests and 65% had returned to pre-injury activity level. Delayed ACL reconstruction resulted in success for a majority of the ACL-reconstructed children. Treatment algorithms for ACL-injured children are discussed.
关于12岁及以下儿童前交叉韧带（ACL）损伤的科学知识有限。在治疗方案上存在大量争议，且尚无基于表现的功能预后的公开数据。将成年ACL损伤患者分为适应者和非适应者很常见，但尚无研究对儿童ACL损伤后基于表现的功能测试进行膝关节功能分类。本研究的目的是评估ACL损伤儿童的中期功能预后，并将他们分为适应者和非适应者。纳入了1996年至2004年因ACL损伤转诊至本机构的12岁及以下儿童。20名未接受手术的受试者（21个膝关节）和6名接受ACL重建的受试者（7个膝关节）在ACL损伤或重建后至少2年接受检查。采用四项单腿跳测试、等速肌力测量和三份功能问卷（IKDC 2000、KOS-ADLS和Lysholm）作为预后指标。在非手术治疗和ACL重建后，恢复到伤前活动水平且在所有跳测试中表现超过90%的儿童被分类为适应者。这26名儿童受伤时平均年龄为10.1岁。在未接受手术的儿童中，65%已恢复到伤前活动水平，50%被分类为适应者。在单腿跳远距离测试、IKDC 2000和Lysholm评分方面，适应者的得分明显高于非适应者。在未接受手术的儿童中，9.5%发生了继发性半月板损伤。在接受ACL重建的受试者中，67%在随访时被分类为适应者。未接受手术的ACL缺陷儿童在基于表现的单腿跳测试中表现出良好的膝关节功能，65%已恢复到伤前活动水平。延迟ACL重建使大多数接受ACL重建的儿童获得成功。讨论了ACL损伤儿童的治疗方案。
