Summary

Paediatric anterior cruciate ligament injuries are surgical challenge. We present encouraging early results with a novel technique of ACL preservation with the use of internal brace.

Abstract

Introduction

Anterior cruciate ligament (ACL) surgery in the paediatric population has long been a challenge. Non-operative treatment will result in persistent instability resulting in chondral/meniscal injuries. With re-rupture rates of up to 53% and persistent instability of up to 94%, historically, the mid-term results of primary open ACL repair were poor. There is a high failure and recurrence rate, up-to 20%, in patients under the age of 18 years undergoing ACL reconstruction. There are increasing concerns of growth plate disturbance with trans-physeal techniques and issues with relatively small diameter grafts in Tanner 1 and 2 patients, which are inadequate. With advancing instrumentation, such as 3.5 mm tunnel drilling, repair and subsequent preservation of the native ACL has become a viable option. The minimally invasive approach of arthroscopic primary ACL repair retains the native ligament. We present our early two-year results.

Methods

Fifteen patients (aged 6 to 16 years) with complete proximal ACL ruptures underwent direct arthroscopic ACL repair reinforced by a temporary internal brace, which was subsequently removed after 3 months. Patient reported outcome measures were collected at 6 months, 1-year and 2-years post operatively.

Results

Seven patients completed data at 1-year, eight patients completed data at 2-years post-operatively. Examination, second-look arthroscopy, and imaging at 3 months confirmed knee stability and complete ACL healing in all cases. There were neither any failures nor complications and no growth disturbance was noted beyond 2 years. Outcome scores (KOOS-Child, Lysholm and Tegner) pre- and post-operatively demonstrated statistically significant improvements following surgery (p<0.001)

Conclusion

ACL repair in young children using this technique negates the requirement and potential morbidity of graft harvest and demonstrates the potential for excellent outcome as an attractive alternative to ACL reconstruction, where an adequate ACL remnant permits direct repair.