Surgical ACL reconstruction has excellent results in the adolescent patient

VIENNA — A 10-year study has found that surgical repair of ACL lesions in adolescent patients has good to excellent results at long-term follow-up.

“We have learned that the conservative for ACL lesions in adolescents is not good,” Gian Luigi Canata, MD, of Italy, said here at the 10th EFORT Congress. “But there are no level I or II studies that have addressed operative techniques or the timing of the reconstruction.”

To address this, Canata and colleagues undertook a retrospective evaluation of case reports of adolescent patients who were surgically treated for ACL reconstruction using two popular surgical techniques: reconstruction with patellar tendon and arthroscopic reinsertion of the ligament.

Two groups

Canata’s data included 75 cases of surgical treatment of instability in patients under the age of 18 years who received their treatment between 1990 and 2006. He divided the group into two subgroups: One group of 59 cases was treated with patellar tendon and a second group of 16 cases with proximal lesions and good ligament quality received arthroscopic repair of the ACL.

Mean follow-up for both groups was 120 months and clinical evaluations were performed using the IKDC (International Knee Documentation Committee) 2000 scores. Radiographic and MRI evaluations were also performed.

Canata said his indications for performing the procedures in these patients are radiographic or MRI evidence of the lesion and demonstrated laxity.

“This is not a good injury for conservative treatment,” he said. “I will sometimes suggest conservative treatment if they do not have a great laxity. But if they come back and there is an increase in laxity … I think they should have surgery.”

No functional compromise

“We found that there was no differences between the two groups in terms of the assessing the ACL with the IKDC or the radiographic assessments and we did not observe and length difference or imbalance with any of the patients,” he said. Overall, 93% of cases had good results with the surgical treatments.

“The use of the patellar tendon for the repair does not result in having compromised the functionality of the extensor apparatus,” he said. “Excellent results are possible both with the patellar tendon and with ACL reinsertion, in the case of proximal lesions and a good quality of the ligament.”

He added that reinsertion with the arthroscopic technique has efficacious results in a high percentage of those studied.

“Above all it is indicated when the young biological age of the patient could mean postponing reconstruction surgery with the risk of secondary lesions and of unsatisfactory results,” he said.

An attendee of the session commented that he has concerns about mobility in his adolescent patients following these procedures.

Canata responded that he has seen no rigidity following the ACL reconstructions.

“It is incredible how happy these patients are,” he said. “Also, there is a high rate of return to sport activity.”

For more information:
Canata GL. ACL reconstruction of insertion in the adolescent: A 10-year follow-up. Paper F39. Presented at the 10th EFORT Congress. 3-6 June 2009. Vienna.