Abstract
The purpose of this study was to compare 2 different strategies of management for ACL rupture in skeletally immature patient.
In group 1, patients were treated in a children hospital by ACL reconstruction with open physis. In group 2, patients were treated in an adult hospital by delayed reconstruction at skeletal maturity assessed radiologically.
Fifty six consecutive patients were included in this retrospective study. Mean time from injury to surgery in group 1 and 2, was 13.5 and 30 months, respectively.
In the overall series, a long time from injury to surgery increased the number of medial meniscal tear (p< 0.0001), but had no influence in the number of lateral meniscal tear (p=0.696). Patients in group 2 exhibited a higher rate of medial meniscal tears (41%) compared to group 1 (16%) (p=0.01). Both groups had the same rate of lateral meniscal tears (p=1). Despite there was no difference between the 2 studied groups in type and location of menisci lesion, patients in group 2 underwent more partial menisectomy (63%) than patients in group 1 (16%) (p=0,014).
One temporary tibial valgus deformity was reported and spontaneously resolved. No definitive growth disturbance was noticed. At 27 months mean follow-up, patients in group 1 expressed better subjective IKDC than in group 2. Objective IKDC and radiological results were similar in both groups.
Early ACL reconstruction in skeletally immature patient, especially if the patient is more than one year to be skeletally mature, has to be promoted despite of growth disturbance risk. This strategy will decrease medial meniscus lesions and partial meniscectomies which occurred more frequently when ACL reconstruction had been delayed until skeletal maturity.
Correspondence should be addressed to: EFORT Central Office, Technoparkstrasse 1, CH – 8005 Zürich, Switzerland. Email: office@efort.org
