Management of ACL Injuries in Children and Adolescents

Abstract

ä Children and adolescent athletes constitute the largest demographic of patients who sustain anterior cruciate ligament (ACL) tears, and the frequency is increasing. ä In ACL-deficient children and adolescents, continued symptoms of instability can result in progressive meniscal and cartilage damage as well as arthritic changes. ä Growth disturbance can occur after ACL surgery in children, and includes tibial recurvatum due to tibial tubercle apophyseal arrest as well as limb-length discrepancy and/or angular deformity due to physeal arrest or overgrowth. ä Several "physeal sparing" and "physeal respecting" ACL reconstruction techniques have been developed for use in skeletally immature patients to minimize the risk of growth disturbance, with favorable clinical outcomes. ä ACL injury prevention strategies include neuromuscular conditioning and may be performed to prevent both initial ACL injury as well as reinjury and injury of the contralateral ACL after reconstruction. Disclosure: No internal or external funding was provided for this project. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/B603).

One in 5 Athletes Sustain Reinjury Upon Return to High-Risk Sports After ACL Reconstruction: A Systematic Review in 1239 Athletes Younger Than 20 Years

“…97 Adolescents are frequently treated with ACLR to prevent further injury to the menisci and articular cartilage and allow for return to sport (RTS). 25,28,38,49,79,100 Although variability exists in RTS rates of adolescents after ACLR, 60,63,85 several studies have reported that 90% or more returned. 26,50,75,86,95 However, there is a justifiable concern over the potential for reinjury in this population.…”

Biomechanical Comparison of Epiphyseal Anterior Cruciate Ligament Fixation Using a Cortical Button Construct Versus an Interference Screw and Sheath Construct in Skeletally Immature Cadaveric Specimens

“…The number of ACL reconstructions performed in the skeletally immature population is growing, and multiple methods of reconstruction exist. 2 , 5 , 7 , 10 , 12 , 36 Many of the techniques used today are adapted from ACL reconstruction techniques in the adult population and utilize the same devices. However, there are inherent structural differences between pediatric and adult bone with regard to mineralization and bone strength, and the performance of these devices in pediatric bone has not been evaluated, to our knowledge.…”

2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries

“…Single bundle transphyseal ACL reconstruction with a quadrupled hamstring graft is the most common (Fig. 4 ) [ 21 , 25 , 38 , 55 , 71 , 114 ]. Therefore, because the surgeon is more likely to be familiar with the key elements of the procedure, it may reduce the risk of intraoperative complications.…”

“…Only soft tissue grafts (not allografts) should be used for ACL reconstruction in paediatric patients with open physes. The quadrupled hamstring graft is most common [ 25 , 38 , 55 , 71 , 114 ]. A quadriceps tendon graft may be used [ 53 ].…”