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Outcomes of Pediatric Posterior Cruciate Ligament Reconstruction: A Systematic Review

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 ped...

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Autores principales: Scarcella, Michael J., Yalcin, Sercan, Scarcella, Nicholas R., Saluan, Paul, Farrow, Lutul D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8485165/
https://www.ncbi.nlm.nih.gov/pubmed/34604428
http://dx.doi.org/10.1177/23259671211032539
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author Scarcella, Michael J.
Yalcin, Sercan
Scarcella, Nicholas R.
Saluan, Paul
Farrow, Lutul D.
author_facet Scarcella, Michael J.
Yalcin, Sercan
Scarcella, Nicholas R.
Saluan, Paul
Farrow, Lutul D.
author_sort Scarcella, Michael J.
collection PubMed
description 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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spelling pubmed-84851652021-10-02 Outcomes of Pediatric Posterior Cruciate Ligament Reconstruction: A Systematic Review Scarcella, Michael J. Yalcin, Sercan Scarcella, Nicholas R. Saluan, Paul Farrow, Lutul D. Orthop J Sports Med Article 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. SAGE Publications 2021-09-28 /pmc/articles/PMC8485165/ /pubmed/34604428 http://dx.doi.org/10.1177/23259671211032539 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Scarcella, Michael J.
Yalcin, Sercan
Scarcella, Nicholas R.
Saluan, Paul
Farrow, Lutul D.
Outcomes of Pediatric Posterior Cruciate Ligament Reconstruction: A Systematic Review
title Outcomes of Pediatric Posterior Cruciate Ligament Reconstruction: A Systematic Review
title_full Outcomes of Pediatric Posterior Cruciate Ligament Reconstruction: A Systematic Review
title_fullStr Outcomes of Pediatric Posterior Cruciate Ligament Reconstruction: A Systematic Review
title_full_unstemmed Outcomes of Pediatric Posterior Cruciate Ligament Reconstruction: A Systematic Review
title_short Outcomes of Pediatric Posterior Cruciate Ligament Reconstruction: A Systematic Review
title_sort outcomes of pediatric posterior cruciate ligament reconstruction: a systematic review
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8485165/
https://www.ncbi.nlm.nih.gov/pubmed/34604428
http://dx.doi.org/10.1177/23259671211032539
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