Anterior cruciate ligament injury in children and adolescents

Although the natural history of anterior cruciate ligament (ACL) injuries in the adult is well documented, the natural history of ACL injury in children and adolescents has not previously been reported. A case note review revealed 31 cases with ACL pathology out of 212 arthroscopies performed in the Adelaide Children's Hospital from November 1980 until June 1986. Partial tears were more common than complete midsubstance tears. In 27 cases there was no bony involvement. All 27 patients were available for analysis. The average age was 14.3 years, with a range of 8-18 years. Twelve of the 27 patients were younger than 14 years old. All patients completed a questionnaire and were interviewed. The average follow-up was 51 months (range 26-87 months). At the time of initial injury, 11 of the 27 patients (41%) had associated pathology. Subsequently, four patients have undergone further arthroscopic surgery, four patients have had a reconstruction of the ACL, and a further three have had reconstruction recommended. We conclude that this is not as benign an injury as was previously believed.