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Strength and laxity in children 1 year after ACL-reconstruction.
Author(s):
Herzog R. (Denmark)
,
Herzog R. (Denmark)
Affiliations:
Lundgaard-Nielsen Mathilde
,
Lundgaard-Nielsen Mathilde
Affiliations:
Rathcke M.
,
Rathcke M.
Affiliations:
Krogsgaard M.
,
Krogsgaard M.
Affiliations:
Warming Susan
Warming Susan
Affiliations:
ESSKA Academy. Herzog R. May 9, 2018; 209414; P05-889
Robert Bennike Herzog
Robert Bennike Herzog
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Abstract
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Objectives: The results of Anterior Cruciate Ligament (ACL) reconstruction in children younger than 16 years are generally reported in small series. We are one of two public hospitals in Denmark, designated to perform these operations. The same technique has been used for several years: a quadruble semitendinosus autograft fixed by an endobutton in both ends is inserted in drill tunnels under fluoroscopy to prevent damage to the epiphyses. We present our prospective data for a 5-year period, equivalent to about half of all pediatric ACL reconstructions in Denmark (population 5,7 millions).

The objective is to describe the outcome of ACL reconstruction in children and adolescents under 16 years by laxity measurements and clinical tests.

Methods: During the period 2012-17 89 children had an ACL reconstruction. The mean age (for both genders) was 13 years (SD 1.6) at the time of operation. After surgery all the children received structured rehabilitation either at the hospital or in the municipality. Followed-up is after 1 and 3 years, and then every second year until the age of 18 years by a physiotherapist, including:
-Laxity measured by rolimeter
-Four hoptests (one single leg hop, 6M timed single leg hop, 3 single leg hop and single leg cross-over hop)
-Power-rig strength test

Results: At present 57 of 71 eligible children (80%) have completed 1-year follow-up test. Fourteen children (20 %) did not attend the 1 year follow-up, and one of those was known to have a re-rupture. The mean age at one-year follow up was 14 years (SD 1.8) ( boys (b) 46 %; girls (g) 54%). The most common reasons for injury among both genders was soccer (b 42 % vs g 29 %) and handball (b 23 % vs g 29%). The left knee was most frequently injured (60 %).
Comparing the injured and uninjured knee at the one year follow-up on all the 4 hop-tests showed a range between 95.4 - 100.9 % for boys and 92.9 - 94.9 % for girls, with the worst outcome for 6M timed hop and cross-over hop for boys and girls, respectively.
The leg extensor power strength compared to the uninjured knee was 102.1 % (SD 18 %) for boys and 95.3 % (SD 24.4 %) for girls. The laxity difference between the injured and uninjured knee was 1.2 mm (SD 1.5) for boys and 1.3 mm (SD 1) for girls.

Conclusions: The Laxity measurement after 1 year showed an acceptable side-to-side difference.
The Hop- and strength tests showed surprisingly small differences between the operated and the non-operated leg, meaning that these children had generally achieved good strength and coordination 1 year after ACL reconstruction.

Keywords:
ACL, children, adolescents, hoptest, laxity,
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