ACL RECONSTRUCTION OR REINSERTION IN THE ADOLESCENT: 10-YEAR FOLLOW UP

Abstract

The conservative treatment of ACL lesions in the adolescent is unfavourable in the long term risking precocious joint deterioration. Nevertheless, literature does not agree on the timing and on the best type of surgery in this age group. The results of ACL repairs with the open technique are evaluated negatively. We present a retrospective evaluation of a case history of adolescents surgically treated with ACL reconstruction with patellar tendon or with arthroscopic reinsertion of the ACL in the case of proximal lesions and of good quality ligamentous tissue.

Materials and methods: From 1990 to 2006, adolescents under 18 were surgically treated for instability as a consequence of ACL rupture. 75 of these were evaluated retrospectively and divided into two groups: 59 cases, mean age 16 years (13–17), 28 males and 31 females were treated with patellar tendon, Group A. 16 cases, mean age 14 years (11–17), 8 males and 8 females, were treated with arthroscopic repair of the ACL (mean time between lesion and surgery 24 days, 2–200, Group B. Mean follow up 120 months (18–204). The evaluation of the results was carried out using the IKDC 2000 score. In all cases a clinical, radiographic and MRI evaluation was performed.

Results: Group A: 50 A, 5 B, 4 C. Group B: 14 A, 1 B, 1 C. Subjective IKDC: Group A mean 97 (80–100). Group B mean 99 (81–100).

Conclusions: The high percentage of good or excellent results (93%) confirms the possibility of a complete functional recovery, after the lesion of the ACL in the adolescent, with surgery. The use of the patellar tendon for the repair does not result as having compromised the functionality of the extensor apparatus. Excellent results are possible both with patellar tendon and with ACL reinsertion in the case of proximal lesions and of a good quality of the ligament. Reinsertion with the arthroscopic technique results efficacious in a high percentage of subjects. Above all, it is indicated when the young biological age of the patient could mean postponing reconstructive surgery with the risk of secondary lesions and of successive unsatisfactory results.