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Knee ligament injuries in children.
The Journal of Bone and Joint Surgery. American Volume
|December 1, 1979
Summary
Pediatric knee injuries involving open physes often require surgery for accurate diagnosis. Even after surgical repair, children may experience persistent ligament instability, highlighting the need for careful evaluation of knee trauma.
Area of Science:
- Orthopedic Surgery
- Pediatric Traumatology
- Sports Medicine
Background:
- Knee ligament injuries in skeletally immature patients with open physes present unique diagnostic and management challenges.
- Accurate assessment of the extent of knee injuries in children can be difficult with initial clinical and radiographic evaluations alone.
Purpose of the Study:
- To evaluate the diagnostic accuracy of initial assessments for knee ligament injuries in children with open physes.
- To determine the outcomes of surgical management for these injuries, focusing on ligamentous stability and potential long-term sequelae.
Main Methods:
- Retrospective study of nine pediatric patients (<14 years) with open physes and knee ligament injuries.
- Inclusion of thorough initial physical and roentgenographic evaluations.
- Surgical exploration to determine the full extent of the injury and subsequent repair.
Main Results:
- Initial evaluations underestimated the extent of injury in 7 of 9 patients, with diagnosis confirmed intraoperatively.
- Five patients had tibial intercondylar eminence avulsion, four with associated collateral ligament injuries and positive anterior drawer sign.
- All patients exhibited postoperative ligament instability, exacerbated by concomitant meniscectomy.
Conclusions:
- Ligamentous knee injuries in children with open physes require a high index of suspicion and surgical intervention for definitive diagnosis.
- Surgical repair does not always restore full ligamentous stability, and meniscectomy may worsen outcomes.
- Long-term monitoring for degenerative arthritis is crucial in this patient population.