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Scientific Articles   |    
The Current Evidence for Treatment of ACL Injuries in Children Is LowA Systematic Review
Håvard Moksnes, PT, MSc1; Lars Engebretsen, MD, PhD2; May Arna Risberg, PT, PhD1
1 Norwegian Research Centre for Active Rehabilitation, Department of Sports Medicine, Norwegian School of Sport Sciences, PB 4014 Ullevål Stadion, 0806 Oslo, Norway. E-mail for H. Moksnes: havard.moksnes@nih.no
2 Orthopaedic Department, Oslo University Hospital (Ullevål), Kirkeveien 166, 0407 Oslo, Norway
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Norwegian Research Centre for Active Rehabilitation, Department of Sports Medicine, Norwegian School of Sport Sciences, PB 4014 Ullevål Stadion, 0806 Oslo, Norway. E-mail for H. Moksnes: havard.moksnes@nih.no
Orthopaedic Department, Oslo University Hospital (Ullevål), Kirkeveien 166, 0407 Oslo, Norway
Investigation performed at the Norwegian Research Centre for Active Rehabilitation, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, and the Orthopaedic Department, Oslo University Hospital, Oslo, Norway

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Jun 20;94(12):1112-1119. doi: 10.2106/JBJS.K.00960
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Abstract

Background: 

There is no consensus on the management of anterior cruciate ligament (ACL) injuries in skeletally immature children, and the methodological quality of published studies is questionable. The transphyseal reconstructions, physeal-sparing reconstructions, and nonoperative treatment algorithms that are advocated have little support in the literature. The purpose of this study was to systematically review the methodological quality of the literature on the management of ACL injuries in skeletally immature children.

Methods: 

We performed a literature search with use of PubMed to identify prospective or retrospective studies whose primary aim was to assess the outcome after operative or nonoperative treatment of ACL injuries in skeletally immature children. To be included in the analysis, a study had to have a mean duration of follow-up of at least two years and a minimum of ten children in the study had to be verified to be skeletally immature. The methodological quality of the included studies was evaluated with use of the Coleman Methodology Score.

Results: 

No randomized controlled trials, two prospective cohort studies, and twenty-nine retrospective studies met the inclusion criteria. The Coleman Methodology Score averaged 44.7 ± 9.2 out of 100 (range, 28 to 62). The methodological deficiencies were most evident with regard to the number of included children, the study design, and the description of rehabilitation protocols, outcome criteria, and outcome assessments.

Conclusions: 

Caution is necessary when interpreting the results of studies on the treatment of ACL injuries in skeletally immature children because of widespread methodological deficiencies. There is a need for appropriately sized prospective studies and detailed descriptions of rehabilitation programs.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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