The Effectiveness of Nonoperative Treatment for Anterior Cruciate Ligament Rupture on Patient-Reported Outcomes and Muscular Strength: A Critically Appraised Topic

The Double-Edged Sword: Anterior Cruciate Ligament Reconstructions on Adolescent Patients-Growth Plate Surgical Challenges and Future Considerations

The management of anterior cruciate ligament (ACL) injuries in pediatric patients presents unique challenges due to the presence of open growth plates in the proximal tibia and distal femur. Delaying ACL reconstruction until skeletal maturity may protect the physes but increases the risk of secondary injuries, such as meniscal tears and chondral damage, due to prolonged joint instability. Conversely, early surgical intervention restores knee stability but raises concerns about potential growth disturbances, including leg-length discrepancies and angular deformities. This narrative review examines current approaches to pediatric ACL management, highlighting the risks and benefits of both conservative and surgical treatments. Additionally, it explores the role of finite element modeling (FEM) as an innovative tool for pre-surgical planning. FEM offers a non-invasive method to optimize surgical techniques, minimize iatrogenic damage to growth plates, and improve patient outcomes. Despite its potential, FEM remains underutilized in clinical practice. This review underscores the need to integrate FEM into pediatric ACL care to enhance surgical precision, reduce complications, and improve long-term quality of life for young patients. By synthesizing available evidence, this review aims to provide clinicians with a comprehensive framework for decision-making and identify future directions for research in pediatric ACL reconstruction.

Tensile Strength of the Achilles Tendon Allograft: A Comparative Study of Graft Preparation Technique

Background/Objectives: The Achilles tendon is a popular allograft option for anterior cruciate ligament (ACL) reconstruction. Structurally, the tendon is known to have a 90-degree rotational fiber track. Preparation techniques, with this consideration, may influence the strength of the graft. This study aims to assess the tensile strength of a novel Achilles tendon allograft harvest procedure following the rotational fiber track. Methods: Both Achilles tendons were harvested from formalin-embalmed cadavers [(n = 20), male n = 13, female n = 7, average age = 70]. Ten cadavers had the right Achilles as the control and the left Achilles as the fiber track sample; 10 cadavers had the opposing designation. Tensile strength was tested utilizing a Bose machine. An unpaired t-test was used to compare data across groups. Results: The average ultimate load for the control group was 874.17 N, with an average elastic stiffness of 76.01 N/mm. The ultimate load for the fiber track group was 807.84 N, with an average elastic stiffness of 64.75 N/mm. No statistically significant difference (p = 0.21) was determined between the average ultimate loads or elastic loads (p = 0.18) across groups. Conclusions: These data suggest that the rotational fiber track method of Achilles allograft has consistent tensile strength and elastic stiffness as compared to the common harvest procedure. The rotational fiber track method for ACL harvesting is a viable alternative option to the common harvest procedure for usage in an ACL reconstruction.

Anterior Cruciate Ligament Tear: Individualized Indications for Non-Operative Management

Anterior cruciate ligament (ACL) rupture represents a common sports injury that is mostly managed operatively. However, non-operative treatment can also play a role, despite the limited high-quality published data on ACL tear management. Both methods have shown favorable outcomes, but clear guidelines based on high-quality research are lacking. Several factors should be considered and discussed with the patient before deciding on the best treatment method. These include patient characteristics and expectations, concomitant injuries, and clinical evaluation, with laxity or/and instability being one of the most essential parameters examined. This should eventually lead to an individualized approach for each patient to ensure the best possible outcome. This review aims to delve into all parameters that are related to ACL rupture and guide physicians in choosing the most appropriate treatment method for each patient.

Non-operative Management of Acute Knee Injuries

PURPOSE OF REVIEW

Acute knee injuries are commonly encountered in both the clinical and sideline setting and may be treated operatively or non-operatively. This article describes an evidence-based approach to non-operative acute knee injury. This includes history, physical exam, imaging, and initial management. In addition, the non-operative management of three such injuries-ligament injury, meniscus injury, and patellar dislocation injury-will be discussed via a case-based practical approach.

RECENT FINDINGS

Aside from grade III ACL tears, most acute knee ligament injuries, especially in the absence of other concurrent injuries, can be treated non-operatively. There is new evidence that acute traumatic meniscus tears in those younger than 40 can be successfully treated non-operatively and can do equally, as well as those that undergo surgery, at 1 year out from injury. Based on the current literature, a short period of knee bracing in extension with progression to weightbearing to tolerance is recommended after initial patellar dislocation. Many of the most common acute knee injuries, including MCL tears, meniscus tears, and patellar dislocations, can be managed non-operatively. A detailed systemic approach to initial evaluation, including pertinent history, physical exam, and appropriate imaging, is essential and complementary to the subsequent non-operative treatment algorithm.