Evaluation of the knee joint structures of pediatric patients with anterior cruciate ligament injury after conservative treatment

Abstract

Background Conservative treatment of pediatric patients with anteromedial instability after ACL rupture is a very topical subject and raises many debates in the scientific community. Results of this treatment are rather controversial both in patients with open physis and in adult patients who reached skeletal maturity. Influence of anteromedial instability on damaging such structures of the knee joint and meniscus and articular cartilage also generates interest. Purpose The purpose is to evaluate results of conservative treatment in young athletes using methods of clinical examination, questionnaires and MRI-diagnostics. Material and methods The study included 20 patients with anteromedial instability aged 13–20 years. Duration of observation was up to 2.7 years (33 months). The patients filled out KOOS-Child and Pedi-IKDC questionnaires. At least two MRI-examinations were done also. The patients were treated conservatively. Results and discussion MRI data indicated that 9 (45%) patients had osteochondral changes in condyles of the both bones. Thinning of the knee cartilage by ≥ 0.7 cm was observed in 14 patients. Eighteen patients has the clinically confirmed knee joint instability. Eight (40%) patients underwent operative treatment later. Conclusion Our study results allowed us to make a conclusion about poor results of the conservative treatment. Only 2 patients returned to previous activities and the knee instability was not observed clinically. The rest of the patients were not satisfied with the treatment results. MRI data and statistical analysis data indicated that the patients had signs of significant weight distribution disorders in the knee joint and also secondary damage of meniscus due to anteromedial instability.