Functional and radiological outcomes following a non-operative treatment algorithm after ACL injuries in skeletally immature children

Abstract

This dissertation has evaluated the functional and radiological outcomes following the implementation of a non-operative treatment algorithm for skeletally immature children after ACL injury. The body of evidence, needed for future experimental studies to investigate the effect of different treatment algorithms in this population, has been strengthened. New knowledge has been provided to assist clinical decision making. An evidence-based treatment algorithm has been developed, and the current methodological quality of the literature on the treatment of skeletally immature children has been investigated. The main conclusions which may have an impact on future clinical practice and research were: I. The methodological quality of the literature on treatment of skeletally immature children after ACL injury was low. In particular we identified a lack of properly sized prospective cohort studies on homogenous populations, few studies including functional outcome measurements, an absence of descriptions of rehabilitation protocols and valid outcome measurements, as well as no randomised clinical trials on the effect of different treatment modalities (Paper II). II. Patient-reported and performance-based outcome measurements did not show clinical relevant changes in knee function in ACL injured skeletally immature children following a non-operative treatment algorithm (Paper III). III. Skeletally immature children remain physically active following a non-operative treatment algorithm after ACL injury, although 38% of the ACL deficient children abandoned a Level 1 activity as their main leisure time sport activity (Paper III). IV. A low incidence of new injuries to the menisci and articular cartilage was found after implementing a non-operative treatment algorithm in ACL injured skeletally immature children (Paper IV).

Paper I: Moksnes H, Engebretsen L, Risberg MA. Management of anterior cruciate ligament injuries in skeletally immature individuals. J Orthop Sports Phys Ther 2012;42(3):172-183.

Paper II: Moksnes H, Engebretsen L, Risberg MA. The current evidence for treatment of ACL injuries in children is low: A systematic review. J Bone Joint Surg Am 2012 June 20;94(12):1112-1119.

Paper III: Moksnes H, Engebretsen L, Eitzen I, Risberg MA. Functional outcomes following a nonoperative treatment algorithm for anterior cruciate ligament injuries in skeletally immature children 12 years and younger. A prospective cohort with 2 years follow-up. Submitted Br J Sports Med December 7, 2012. Revision submitted January 30, 2013. Accepted February 3, 2013. Br J Sports Med 2013 May;47(8):488-94.

Paper IV: Moksnes H, Engebretsen L, Risberg MA. Low incidence of new meniscus and cartilage injuries after non-operative treatment of anterior cruciate ligament tears in skeletally immature children: Prospective cohort study. Submitted Am J Sports Med, October 18, 2012. Revision submitted March 10, 2013. Accepted April 2, 2013.