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Functional outcome one year after anterior cruciate ligament injury in non-operated children 12 years or younger

Functional outcome one year after anterior cruciate ligament injury in non-operated children 12 years or younger. Håvard Moksnes , Lars Engebretsen and May Arna Risberg NAR, Department of Orthopaedics, Oslo University Hospital Hjelp 24 NIMI Norwegian School of Sport Sciences. The Dilemma.

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Functional outcome one year after anterior cruciate ligament injury in non-operated children 12 years or younger

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  1. Functional outcome one year after anterior cruciate ligament injury in non-operated children 12 years or younger Håvard Moksnes, Lars Engebretsen and May Arna Risberg NAR, Department of Orthopaedics, Oslo University Hospital Hjelp 24 NIMI Norwegian School of Sport Sciences

  2. The Dilemma The danger of growth disturbance AND the child’s compliance with rehabilitation related to ACL reconstruction versus the danger of early osteoarthritis subsequent to a secondary meniscus injury after a period of non-operative management

  3. Litterature Scientific evidence is limited Expert opinions and case series Mix of adolescents and children No prospective studies with performance based outcome measurements Mohtadi 2006, Beynnon 2005

  4. One systematic review Clin J Sport Med Volume 16, Number 6, November 2006

  5. The study designs are inadequate to answer the question of whether early or delayed ACL reconstruction results in the best possible outcome in skeletally immature individuals Mohtadi & Grant 2006

  6. Design Prospective cohort study of children with ACL rupture sustained at age 12 years or younger

  7. Purpose • To describe the functional outcome in children 12 years or younger after ACL injury

  8. Inclusion criteria Children with acute ACL injury at the age of 12 years or younger Intrasubstance ACL rupture History Clinical examination MRI

  9. Treatment plan • Primary non-operative treatment • Physical therapist 1-2/month • Brace when performing pivoting sports • Surgical treatment considered when: • Repeated giving way episodes • Repearable menicus injury

  10. Rehabilitation • Home based exercises 3-7/week • Max 3 exercises • Max 10 minutes • Functional approach • Neuromuscular training • Dynamic stability in hopping and landing

  11. MethodsFunctional evaluation Functional assessment at baseline Follow-up annually Four single leg hop tests Isokinetic muscle strength test Biodex 6000; 5 reps 60°/s

  12. MethodsFunctional questionnaires KOS-ADLS KOOS IKDC 2000 VAS of knee function

  13. MethodsMonitoring activities and knee function Internet based questionnaire Submitted monthly by e-mail Compliance > 90 % Activities Giving way episodes 2 episodes within 3 months → Assessment by surgeon

  14. MethodsMonitoring activities and knee function

  15. Material (May 2010) 44 children 29 boys and 15 girls Median age 11.3 years (min 7.0, max 12.9) 19 right and 26 left knees 1 bilateral

  16. Activities at time of injury Alpine skiing n=25 Soccer n=11 Cycling n=2 Playing n=2 Team handball n=2 Trampoline n=2 Motocross n=1

  17. Preliminary results (May 2010)Surgical treatment • 32 non-operated children • 2 sutured medial menisci • 1 partial medial meniscus resection • 12 ACL reconstructed – all hamstrings • 3 medial and 2 lateral meniscus sutures • 2 partial lateral meniscus resections • 1 injury to nerve and artery

  18. AcknowledgementsNorwegian Research Centre for Active Rehabilitation (NAR) • Grant # 2 RO1 HD 37985-05 • Southern and EasternNorway Regional Health Authority • Norwegian Foundation for Health and Rehabilitation • Hjelp24 NIMI • NorwegianSchoolof Sport Sciences • University of Delaware, Department ofPhysicalTherapy

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