|
Year |
2002 |
|---|---|
|
Question Number |
63 |
|
Category |
Sports Medicine |
Question
A 14-year-old football player sustains a midsubstance tear of the anterior cruciate ligament. An MRI scan shows no evidence of meniscal injury. Nonsurgical management of this injury will most likely resuly in
1- recurrent instability with a probable meniscal tear
2- a limb-length discrepancy
3- a stable knee at skeletal maturity
4- early degenerative joint changes
5- varus deformity
Figures
Answer (click for answer)
Preferred response: 1.
In the first referenced article Angel and Hall report on 27 patients age 8-18 with an ACL injury, 18 of which had a partial tear, 7 had a midsubstance tear and 2 had a femoral avulsion. Treatment consisted of PT with the exception of one patient with a femoral avulsion. This patient underwent primary repair. Five of the patients with a midsubstance tear had an associated meniscal tear at time of injury, 1 of these patients had another associated pathology at time of injury and 1 other patient developed subsequent pathology at mean follow-up. None of these patients were able to return to their pre-injury level of sport. After mean follow-up of 51 months 11 of the 27 patients in the study were dissatisfied with their result due to inability to return to pre-injury level of sport, pain and swelling.
Reference: 1) Angel KR, Hall DJ: Anterior cruciate ligament injury in children and adolescents. Arthroscopy 1989;5:197-200. 2) Janarv PM, Nystrom A, Werner S, Hirsch G: Anterior cruciate ligament injuries in skeletally immature patients. J Pediatr Orthop 1996;16:673-677. 3) Pressman AE, Letts RM, Jarvis JG: Anterior cruciate ligament tears in children: An analysis of operative versus nonoperative treatment. J Pediatr Orthop 1997;17:505-511.