Outcomes of Initial Nonoperative Management of Partial Anterior Cruciate Ligament Tears in Pediatric Patient

Partial anterior cruciate ligament (pACL) injuries are a challenging clinical problem without reliable diagnostic criteria and scant data on outcomes. The majority of prior studies defined a partial tear either arthroscopically or by exam under anesthesia, and have focused on the surgical management.This study investigates the outcomes of partial anterior cruciate ligament tears identified with data available in the clinic.

We conducted a retrospective cohort study, with follow-up survey of pediatric patients aged between the ages of 8 and 18 years who were diagnosed with a partial anterior cruciate ligament tear in orthopaedic and sports medicine clinics at an urban, level-1 pediatric trauma center between 1/1/2009 and 12/31/2019, to determine the prevalence of progression to anterior cruciate ligament insufficiency. Secondarily, we (1) determined the rate of meniscus tears associated with partial anterior cruciate ligament tears, (2) determined the mean time to progression to anterior cruciate ligament insufficiency, and (3) assessed risk factors associated with progression to anterior cruciate ligament insufficiency. Demographic and clinic data were collected from the medical records.

Three hundred and sixty-five patients with partial anterior cruciate ligament tears were identified. We had a response rate of 27% (n = 99). Fifteen patients had immediate operative management. The remaining eighty-four, treated nonoperatively at the onset, were analyzed. Of the whole cohort, 21 of 84 (25%) patients progressed to anterior cruciate ligament insufficiency. After accounting for censored data, the imputed median survival time of a partial anterior cruciate ligament tear was 11.4 months (Interquartile range [IQR]: 5.5-28.6 months) after returning to sports. No significant differences were found in sex, sports participation, body mass index, contusion pattern, associated injuries on magnetic resonance imaging, or physical therapy or bracing duration existed between those who progressed to anterior cruciate ligament insufficiency and those that did not.

A substantial proportion (25%) of partial anterior cruciate ligament tears progress to an anterior cruciate ligament insufficiency. Progression does not appear to be independently associated with clinical and radiographic findings or management practices.

Level III.