Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Mininder Kocher, Boston Childrens Hospital, US
- Second opponent: Professor Jon Karlsson, Sahlgrenska Academy, University of Gothenburg, Sweden
- Third member and chair of the evaluation committee: Professor Inger Holm, University of Oslo
Chair of the Defence
Professor II Tore Kvien, University of Oslo
Principal Supervisor
Professor Lars Engebretsen, University of Oslo
Summary
Pediatric anterior cruciate ligament injuries
-management, treatment rationale and long-term outcomes
Pediatric anterior cruciate ligament (ACL) injuries are believed to be increasing due to the rapid surge in the number of children undergoing ACL reconstructive surgery. This trend is alarming due to the high risk of re-injuries to the affected knee, and the potential development of early-onset knee osteoarthritis.
Clinical decision making regarding ACL injuries in children is challenging because current evidence is inconsistent and has scientific limitations. Treatment is controversial, especially regarding surgical intervention. Despite weak scientific evidence, a common clinical dogma has been to advocate early ACL reconstructive surgery in order to protect the other important structures in the knee such as menisci and cartilage.
This thesis has demonstrated that children with ACL injuries require a multidisciplinary approach in order to optimize recovery and prevent further knee injuries. High-quality rehabilitation and injury prevention are essential for all patients, but there is no consensus regarding surgical intervention. The clinical study in this thesis showed that most young adults who sustained an ACL injury during childhood had overall good long-term outcomes following primary non-operative treatment with optional delayed surgery. In addition, there is very low certainty of evidence regarding the risk of new meniscal tears after ACL injury, and this evidence is insufficient to support decision making. Thus, the study findings challenge the current clinical dogma that all children with ACL injury require early reconstructive surgery.
In conclusion, this thesis supports an individualized treatment approach and suggests that non-operative treatment has a role in the management of pediatric ACL injuries. However, reconstructive ACL surgery is advocated for those children with additional meniscal injuries that require repair, and/or those who suffer from knee joint instability over time.
Additional information
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