Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway.
Am J Sports Med. 2019 Jan;47(1):22-30. doi: 10.1177/0363546518810750. Epub 2018 Nov 26.
There is no consensus regarding the best treatment approach for skeletally immature children with anterior cruciate ligament (ACL) injuries. High-quality studies with long-term follow-up are lacking, and evidence to support decision making is limited.
To evaluate functional and patient-reported outcome, surgical history, and complications among young adults who sustained an ACL injury before the age of 13 years and were treated with active rehabilitation and the option of delayed ACL reconstruction if needed.
Case series; Level of evidence, 4.
Forty-six children aged <13 years with a total intrasubstance ACL injury were included. None of these patients had additional injuries that warranted early surgery. At final follow-up at a mean 8 years after the time of injury, 44 patients remained in the study. The same test battery was conducted at baseline, 1 and 2 years, and final follow-up at approximately 18 years of age. The test battery included functional tests (hop tests and isokinetic muscle strength tests of quadriceps and hamstrings), patient-reported outcome measures (including the Knee injury and Osteoarthritis Outcome Score and the International Knee Documentation Committee Subjective Knee Form), and clinical examination. Medical records were reviewed to assess surgical history and complications.
At a mean 8 years of follow-up, 24 patients (55%) had undergone ACL reconstruction, and 16 (36%) had undergone meniscal surgery. Quadriceps muscle strength symmetry was >90% for 30 patients (68%). Mean leg symmetry indexes for hop and strength tests were consistently >90%, except for the single-hop test and hamstrings muscle strength for ACL-reconstructed knees. Mean ± SD International Knee Documentation Committee scores were 86.3 ± 13.7 for the ACL-reconstructed knees and 90.6 ± 11.8 for the nonreconstructed knees. At final follow-up, forty patients (91%) remained active in sports, but 29 (66%) restricted their activity level to nonpivoting sports.
Active rehabilitation may have a role in treatment of children with ACL injury. Approximately 50% of children may cope well, even to adulthood, without a surgical intervention. The other half may develop instability that warrants ACL reconstruction, and one-third may require meniscal surgery.
对于前交叉韧带（ACL）损伤的骨骼未成熟儿童，尚无最佳治疗方法的共识。缺乏高质量、长期随访的研究，支持决策的证据有限。
评估在 13 岁以下发生 ACL 损伤并接受积极康复治疗和必要时选择延迟 ACL 重建的年轻成年人的功能和患者报告结果、手术史和并发症。
病例系列；证据水平，4 级。
纳入 46 名年龄<13 岁的 ACL 完全撕裂伤患儿。这些患者均无需要早期手术的其他损伤。在受伤后平均 8 年的最终随访时，44 名患者仍在研究中。在基线、1 年和 2 年以及最终随访时（约 18 岁），采用相同的测试组合进行评估。测试组合包括功能测试（跳跃测试和股四头肌和腘绳肌的等速肌力测试）、患者报告的结果测量（包括膝关节损伤和骨关节炎结果评分以及国际膝关节文献委员会主观膝关节评分）和临床检查。审查病历以评估手术史和并发症。
在平均 8 年的随访中，24 名患者（55%）接受了 ACL 重建，16 名患者（36%）接受了半月板手术。30 名患者（68%）的股四头肌肌力对称性>90%。跳跃测试和力量测试的平均腿对称性指数持续>90%，除了 ACL 重建膝关节的单腿跳跃测试和腘绳肌力量。ACL 重建膝关节的平均±SD 国际膝关节文献委员会评分（ICKS）为 86.3±13.7，未重建膝关节为 90.6±11.8。在最终随访时，40 名患者（91%）仍积极参加运动，但 29 名患者（66%）将活动水平限制在非旋转运动。
积极康复可能在儿童 ACL 损伤的治疗中发挥作用。大约 50%的儿童即使成年后也可能无需手术干预就能很好地应对。另一半可能会出现不稳定，需要进行 ACL 重建，三分之一可能需要半月板手术。
