Jin Hongfu, Tahir Nouman, Jiang Shide, Mikhail Herasimenka, Pavel Volotovski, Rahmati Masoud, Lee Seung Won, Xiao Wenfeng, Li Yusheng
Department of Orthopedics, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
Sports Med Open. 2025 Apr 23;11(1):40. doi: 10.1186/s40798-025-00844-7.
Due to rising sports participation, anterior cruciate ligament (ACL) tears are increasingly prevalent in children and adolescents. This systematic review aimed to evaluate and summarize the management strategies for ACL injuries in children and adolescents.
A comprehensive search of PubMed, Embase, Web of Science, and Cochrane Library databases was conducted to identify studies reporting outcomes of ACL injuries in children and adolescents. Key outcomes were synthesized descriptively, including knee instability, secondary damage, growth disturbances, and return-to-sport (RTS) rates.
A total of 7,507 publications were initially screened, with 105 studies involving 8294 children or adolescents satisfying the inclusion criteria. Conservative treatments were associated with elevated rates of knee instability (35.85-100%), secondary meniscal and cartilage damage, and long-term degenerative changes. Conversely, surgical interventions, including physeal-sparing and transphyseal techniques, demonstrated superior outcomes with lower instability rates (0-7.41%), fewer complications, and higher RTS rates (83.4-92.6%). Pooled RTS rates for conservative treatments were 44.0% (95%CI: 0.018-0.927), while physeal-sparing ACL reconstruction showed a pooled RTS rate of 92.6% (95%CI: 0.732-1.000) and transphyseal ACL reconstruction reported an RTS rate of 83.4% (95%CI: 0.722-0.924).
Conservative management of ACL injuries in children and adolescents is linked to higher rates of knee instability, secondary meniscal and cartilage damage, and degenerative changes. In contrast, surgical interventions, such as physeal-sparing and transphyseal techniques, yield better outcomes in knee stability, complications reduction, and RTS rates. However, risks such as graft rupture, repeat surgeries, and potential growth disturbances emphasize the importance of tailoring surgical approaches to the patient's growth stage and anatomical characteristics.
由于参与体育运动的人数不断增加，儿童和青少年前交叉韧带（ACL）撕裂日益普遍。本系统评价旨在评估和总结儿童和青少年ACL损伤的治疗策略。
全面检索PubMed、Embase、Web of Science和Cochrane图书馆数据库，以识别报告儿童和青少年ACL损伤结局的研究。对关键结局进行描述性综合分析，包括膝关节不稳定、继发性损伤、生长发育障碍和重返运动（RTS）率。
初步筛选出7507篇文献，其中105项研究涉及8294名符合纳入标准的儿童或青少年。保守治疗与膝关节不稳定率升高（35.85%-100%）、半月板和软骨继发性损伤以及长期退行性改变有关。相反，包括保留骨骺和经骨骺技术在内的手术干预显示出更好的结局，不稳定率较低（0%-7.41%），并发症较少，RTS率较高（83.4%-92.6%）。保守治疗的汇总RTS率为44.0%（95%CI：0.018-0.927），而保留骨骺的ACL重建的汇总RTS率为92.6%（95%CI：0.732-1.000），经骨骺ACL重建的RTS率为83.4%（95%CI：0.722-0.924）。
儿童和青少年ACL损伤的保守治疗与膝关节不稳定、半月板和软骨继发性损伤以及退行性改变的发生率较高有关。相比之下，保留骨骺和经骨骺技术等手术干预在膝关节稳定性、减少并发症和RTS率方面产生更好的结局。然而，移植物破裂、再次手术和潜在生长发育障碍等风险强调了根据患者的生长阶段和解剖特征调整手术方法的重要性。
