Norwegian Research Center for Active Rehabilitation, Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
J Orthop Sports Phys Ther. 2012 Mar;42(3):172-83. doi: 10.2519/jospt.2012.3608. Epub 2011 Sep 4.
Anterior cruciate ligament (ACL) injuries in skeletally immature individuals remain a challenge for the child, the parents, orthopaedic surgeons, and physical therapists. The main challenges are the potential risk of recurrent instability, secondary injuries following nonoperative treatment, and the risks involved with surgical treatment due to the vulnerability of the epiphyseal growth plates. We first present the physiological background for considerations that must be made when advising on treatment alternatives for skeletally immature individuals after ACL injury. The implications of continuous musculoskeletal development for treatment decisions are emphasized. No randomized controlled trials have been performed to investigate outcomes of different treatment algorithms. There is no consensus in the literature on clinical treatment decision criteria for whether a skeletally immature child should undergo transphyseal ACL reconstruction, physeal sparing ACL reconstruction, or nonoperative treatment. Additionally, well-described rehabilitation programs designed for either nonoperative treatment or postoperative rehabilitation have not been published. Based on the currently available evidence, we propose a treatment algorithm for the management of ACL injuries in skeletally immature individuals. Finally, we suggest directions for future prospective studies, which should include development of valid and reliable outcome measures and specific rehabilitation programs.
在骨骼未成熟的个体中，前交叉韧带（ACL）损伤仍然是儿童、家长、骨科医生和物理治疗师面临的挑战。主要的挑战是复发性不稳定的潜在风险、非手术治疗后的继发损伤，以及由于骺板生长板脆弱而导致的手术治疗相关风险。我们首先介绍了在为 ACL 损伤后骨骼未成熟个体提供治疗选择建议时必须考虑的生理背景。强调了连续的肌肉骨骼发育对治疗决策的影响。目前还没有进行随机对照试验来研究不同治疗方案的结果。在文献中，对于骨骼未成熟的儿童是否应进行经骺板 ACL 重建、骺板保留 ACL 重建或非手术治疗，没有达成共识。此外，也没有为非手术治疗或术后康复设计的描述良好的康复计划。基于目前的证据，我们提出了一种骨骼未成熟个体 ACL 损伤的治疗方案。最后，我们为未来的前瞻性研究提出了建议，包括制定有效和可靠的结果测量和特定的康复计划。
