The Effects of Anterior Cruciate Ligament Lesion on the Articular Cartilage of Growing Goats

By Francesco Falciglia, MD, PhD; Giuseppe Mastantuoni, MD; Vincenzo Guzzanti, MD, PhD

ORTHOPEDICS 2009; 32:812

Abstract

Treatment of anterior cruciate ligament (ACL) injury in skeletally immature patients is controversial. The growth plate could be damaged if treated with the reconstruction techniques used to treat instability in adults. For this reason, many authors postpone surgical treatment until skeletal maturity, but the acceptable length of time that treatment can be postponed without causing irreversible damage to the articular cartilage in children with ACL injury is unknown. Until now, no studies have described the pathological findings and the evolution of the lesions of the articular cartilage during the growing period. For this reason, an experimental study on 16 6-month-old, skeletally immature goats was performed. A complete ACL lesion was achieved by removing the ligament. Two animals per group were sacrificed at intervals of 1, 3, 6, and 9 months postoperatively, and macroscopic and microscopic evaluations were performed. The presence of meniscal injury and articular cartilage lesions with progressive aspects were hystologically underlined. The hystological observations showed that the complete ACL lesion causes irreversible articular cartilage alterations in growing goats 3 months after injury. These experimental data suggest that ACL reconstruction in growing patients with ACL injury and instability should be indicated without waiting until skeletal maturity.
Anterior cruciate ligament (ACL) injury in teenagers is now seen so frequently that it is the subject of much attention.1-18 In adults, the problem of therapy is approached with a careful selection of the cases to be treated conservatively.19 Some authors strongly believe that the results of conservative treatment in young patients with complete ACL lesion are not satisfactory and that valid alternative therapeutic solutions is necessary.9,10,13,20-22 Because the greatest problems encountered are associated with the presence of the growth plate, ACL isometric reconstruction is performed when skeletal maturity is complete.