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Outcomes of Pediatric Posterior Cruciate Ligament Reconstruction: A Systematic Review
Michael J Scarcella1, Sercan Yalcin1, Nicholas R Scarcella1
1Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA.
Insights
Surgical treatment of posterior cruciate ligament (PCL) injuries in pediatric patients yields good outcomes and return to activity. This systematic review highlights the need for further research due to limited study quality and sample size for PCL repair and reconstruction in this population.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Sports Medicine
Background:
- Surgical management of posterior cruciate ligament (PCL) injuries in pediatric patients is infrequently reported in medical literature.
- Limited data exists on the specific injury patterns, outcomes, and potential complications associated with operative PCL treatment in skeletally immature individuals.
Purpose of the Study:
- To systematically review and evaluate the presentation, injury patterns, treatment outcomes, and complications of surgically managed posterior cruciate ligament (PCL) injuries in pediatric patients.
- To test the hypothesis that pediatric patients undergoing surgical PCL treatment will experience favorable patient-reported outcomes without significant long-term radiographic changes or complications.
Main Methods:
- A systematic literature review was conducted across major databases (PubMed, Medline, EMBASE, Scopus, Cochrane) from 1975 to December 2019.
- Studies included pediatric patients with surgically treated PCL injuries, excluding case reports, non-clinical results, reviews, and non-English papers.
- Methodological quality was assessed using the MINORS criteria.
Main Results:
- Four studies involving 43 knees in 42 pediatric patients were analyzed.
- Motor vehicle accidents (39.5%) and sports injuries (35%) were primary causes; tear patterns included midsubstance (42%), tibial avulsion (37%), and femoral avulsion (21%).
- Good patient-reported outcomes, return to activity, and satisfactory posterior stability were reported, with arthrofibrosis (7%) as the most common complication and osteoarthritis in 21% of knees.
Conclusions:
- Surgical repair or reconstruction of posterior cruciate ligament (PCL) injuries in pediatric patients can lead to favorable patient-reported outcomes and successful return to activity.
- The current evidence base is limited by the quality and small sample size of included studies, underscoring the need for future research.
- This review establishes a baseline for future investigations into PCL repair and reconstruction in the pediatric population.
Background:
Little has been reported in the literature regarding surgical treatment of posterior cruciate ligament (PCL) injuries in pediatric patients.
Purpose/Hypothesis:
The purpose was to evaluate presentation, injury pattern, outcomes, and complications of surgically managed PCL injuries in pediatric patients. It was hypothesized that pediatric patients would have good patient-reported outcomes and no significant radiographic changes or complications.
Study Design:
Systematic review; Level of evidence, 4.
Methods:
A literature search was performed using PubMed, Medline, EMBASE, Scopus, and Cochrane databases between 1975 and December 16, 2019. Search terms included "posterior cruciate ligament," "peel-off injury," "avulsion," "PCL," "pediatric," "skeletally immature," and "adolescent." Included were studies on pediatric patients with PCL injuries managed operatively. Exclusion criteria included case reports, studies not reporting clinical results, reviews, abstract or conference papers, or papers not in the English language. Quality assessment was performed on all included studies using the MINORS (Methodological Index for Non-Randomized Studies) criteria.
Results:
Four articles comprising 43 knees in 42 patients met the criteria and were included. Motor vehicle accidents were the most common mechanism of injury (39.5%; n = 17/43), followed by sports-related injuries (35%; n = 15/43). All studies commented on tear pattern, with the following distribution: 42% (n = 18/43) midsubstance tears, 37% (n = 16/43) tibial avulsions, and 21% (n = 9/43) femoral avulsions. Overall, good patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score and Pediatric International Knee Documentation Committee, Tegner, and Lysholm scores) and return to activity, as well as satisfactory posterior stability (KT-1000 arthrometer, posterior drawer test, and kneeling radiographs) and range of motion, were reported. There was no significant leg-length discrepancy or angular deformity reported. Arthrofibrosis was reported in 7% of postoperative knees and was the most commonly reported complication. Osteoarthritis was reported in 21% (n = 9/43) of knees. The average MINORS score was 7 (range, 6-8) for noncomparative studies and 10 for comparative studies.
Conclusion:
Good patient-reported outcomes and return to activity can be obtained using repair or reconstruction. This evidence was limited by the quality of the included studies and overall small sample size; however, this review serves as a baseline for futures studies on PCL repair/reconstruction in pediatric patients.
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