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Partial Tears of the Anterior Cruciate Ligament in Children and Adolescents

Mininder S. Kocher, MD, MPH^,,, Lyle J. Micheli, MD, David Zurakowski, PhD and Anthony Luke, MD, MPH

Division of Sports Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
Harvard School of Public Health, Boston, Massachusetts

Presented at the interim meeting of the AOSSM, San Francisco, California, March 2001, and the annual meeting of the American Academy of Orthopaedic Surgeons, Orlando, Florida, March 2000.

Address correspondence and reprint requests to Mininder S. Kocher, MD, MPH, Department of Orthopaedic Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115

Background: The functional outcome after partial anterior cruciate ligament tears in children and adolescents treated without reconstruction has not been established.

Hypothesis: Nonreconstructive management of partial anterior cruciate ligament tears can be effective in certain pediatric patients.

Study Design: Prospective cohort study.

Methods: We studied 45 skeletally mature and immature patients 17 years of age or less who had an acute hemarthrosis, magnetic resonance imaging signal changes, grade A or B Lachman and pivot shift result, and an arthroscopically documented partial anterior cruciate ligament tears. All patients were treated without reconstruction, underwent a structured rehabilitation program, and were followed up for a minimum of 2 years.

Results: Fourteen patients (31%) underwent subsequent reconstruction. Significant associations with subsequent reconstruction included tears that were greater than 50%, predominantly posterolateral tears, a grade B pivot shift test result, and older chronologic and skeletal age. Among patients who did not require reconstruction, those with tears that were greater than 50% or predominantly posterolateral had significantly lower Lysholm, satisfaction, and Cincinnati Knee Scale scores.

Conclusions: Nonreconstructive management is recommended for partial anterior cruciate ligament tears in children and adolescents 14 years of skeletal age or younger with normal or near-normal Lachman and pivot shift results. Reconstruction is recommended in older athletes or in those with greater than 50% or predominantly posterolateral tears.

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