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Prevention, treatment, and rehabilitation of anterior cruciate ligament injuries in children

Authors Lang PJ, Sugimoto D, Micheli LJ

Received 4 February 2017

Accepted for publication 7 April 2017

Published 12 June 2017 Volume 2017:8 Pages 133—141


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Prof. Dr. Andreas Imhoff

Pamela J Lang,1,2 Dai Sugimoto,1–3 Lyle J Micheli1–3

1Division of Sports Medicine, Department of Orthopedics, Boston Children’s Hospital, 2Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, 3The Micheli Center for Sports Injury Prevention, Waltham, MA, USA

Abstract: As more children and adolescents participate in competitive organized sports, there has been an increase in the reported incidence of anterior cruciate ligament (ACL) injuries in these age groups. ACL injuries in skeletally immature athletes present a challenge, as reconstruction must preserve the physis of the distal femur and of the proximal tibia to avoid growth disturbances. Historically, a skeletally immature athlete with an ACL injury was treated with a brace and activity modification until skeletal maturity, with ACL reconstruction being performed at that time in the “non-copers” who experienced instability. More recently, evidence has shown that delayed reconstruction may lead to increased damage to the meniscus and articular cartilage. As a result, early reconstruction is favored to protect the meniscus and allow continued physical activity. While adolescents at or those near skeletal maturity may be treated with standard reconstruction techniques, they may result in growth disturbances in younger athletes with significant growth remaining. In response to the growing need for ACL reconstruction techniques in skeletally immature individuals, physeal-sparing and physeal-respecting reconstruction techniques have been developed. In addition to the advancements in surgical technique, ACL injury prevention has also gained attention. This growing interest in ACL prevention is in part related to the high risk of ACL re-tear, either of the ACL graft or of the contralateral ACL, in children and adolescents. Recent reports indicate that well-designed neuromuscular training programs may reduce the risk of primary and subsequent ACL injuries.

Keywords: skeletally immature, neuromuscular training, surgical techniques, physeal-sparing

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