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Treatment of Posterior Cruciate Ligament Injuries in Pediatric and Adolescent Patients

Kocher, Mininder S. MD, MPH*,†; Shore, Brett MD*; Nasreddine, Adam Y. MA*; Heyworth, Benton E. MD*

Journal of Pediatric Orthopaedics: September 2012 - Volume 32 - Issue 6 - p 553–560
doi: 10.1097/BPO.0b013e318263a154
Trauma
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Background: There is sparse literature regarding the outcomes of treatment for posterior cruciate ligament (PCL) injuries in pediatric and adolescent patients. PCL injuries are rare and are often treated conservatively. The purpose of this study was to review 2 separate cohorts of patients with pediatric and adolescent PCL injuries: those treated surgically with direct repair or ligament reconstruction and those managed nonoperatively.

Methods: Twenty-five patients 18 years or younger underwent treatment of 26 PCL injuries (1 bilateral) at a single institution between 1993 and 2009. Fourteen patients (15 knees) underwent operative treatment, while 11 patients were treated nonoperatively. Demographic and clinical features of each group were reviewed, and validated functional outcome measures [Pediatric International Knee Documentation Committee (Pedi-IKDC), Lysholm, and Tegner scores] were analyzed.

Results: Eleven patients (6 females; mean age, 14.4 y) who sustained PCL injuries were treated nonoperatively, At a mean clinical follow-up of 26.7 months, none of the patients who underwent nonoperative treatment had symptomatic instability, with a 100% return-to-play rate. The mean Pedi-IKDC, Lysholm, and Tegner scores were 87.4, 89.0, and 7.5, respectively. In the 15 knees of 14 patients who underwent surgery (4 female; mean age, 15.1 y) mean clinical follow-up was 27.8 months. All of the patients achieved full or near-full range of motion, and none of the patients showed growth arrest or angular deformity. However, 1 patient showed mild joint-space narrowing, and the mean Pedi-IKDC, Lysholm, and Tegner scores were 81.3, 80.1, and 7.2, respectively. Patients who had sustained knee dislocations had lower Pedi-IKDC scores than those who had not dislocated, 70.2 versus 85 (P=0.047).

Conclusions: Outcomes for nonoperative treatment of partial PCL tears or nondisplaced avulsion injuries are good in young patients. PCL repair or reconstruction is a safe and viable treatment option in pediatric and adolescent patients with multiligament injuries or those with isolated PCL injury who have failed conservative treatment, with outcomes related to the severity of the initial injury.

Level of evidence: Level IV, retrospective case series.

*Department of Orthopaedic Surgery, Division of Sports Medicine, Children’s Hospital Boston

Harvard Medical School, Boston, MA

None of the authors received any external financial reward pertaining to the completion of this study.

The authors declare no conflict of interest.

Reprints: Mininder S. Kocher, MD, MPH, Department of Orthopaedic Surgery, Division of Sports Medicine, Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115. E-mail: mininder.kocher@childrens.harvard.edu.

© 2012 Lippincott Williams & Wilkins, Inc.