Unique Considerations for the Pediatric Athlete During Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction

Abstract

Anterior cruciate ligament (ACL) injuries and surgical intervention in the pediatric population have increased in the recent years. Although surgical techniques have advanced, evidence-based rehabilitation guidelines that consider all aspects of the youth athlete are currently lacking. The purpose of this commentary is to review the current evidence on unique considerations for the pediatric and adolescent population during rehabilitation and return to sport after ACL reconstruction (ACLR), with a focus on children under 18 years of age. This review revealed that returning a youth athlete to sport after ACLR requires knowledge and appreciation of various aspects of the growing athlete different from adults. In addition to postoperative precautions that contribute to a slow rehabilitation process, young athletes need additional time for strength gains. Address risk of reinjury and for contralateral injury by using neuromuscular training and rigorous return-to-sport training programs. Consider return to sport after 9 months because the reinjury rate is high in this population. A combination of time and objective measures, both quantitative and qualitative criteria, and psychological readiness should be used to assess readiness to return to sport and decrease risk of future injury. Healthcare providers should be aware of the psychosocial impact of injury on the youth athletes and refer to sport psychology when necessary. Level of Evidence: Level V.O ver the last 2 decades, anterior cruciate ligament (ACL) injuries and surgical intervention in children and adolescents have been increasing. [1][2][3][4][5][6][7] This increase is often attributed to increased participation in competitive organized sports, 8 early sports specialization, 9 and year-round training and competition. 10 Furthermore, advancements in surgical techniques allow for early reconstruction of the ACL in the

Approximately half of pediatric or adolescent patients undergoing revision anterior cruciate ligament reconstruction return to the same level of sport or higher: A systematic review

“…Failure of r-ACLR represents a significant issue in paediatric and adolescent patients. In addition to its acute physical and psychosocial impacts [50]. Particularly, chronic ACL-deficiency has been suggested to accelerate the development of osteoarthritis, a devastating consequence for young patients [51][52][53].…”

The Influence of Psychosocial Factors on Patients Undergoing Anterior Cruciate Ligament Reconstruction

“…Patients' descriptions of feelings include: burden, worry, frustration, hopelessness, devastation, and isolation. 23,30,36,52,68 Mental health conditions, such as anxiety and depression, may increase in severity in response to injury and be detrimental to outcomes. 46 Schaffer et al 58 observed outcomes of patients stratified into 3 cohorts: clinical diagnosis of depression, situational depression, and no depression.…”

“…25,68 Patients are further dissatisfied when shown a lack of attention and/or generalized treatment. 36 Patients and their families report educational resources and consistent communication would better the experience, allowing collaborative decision-making and supportive care. 25,33,53,68 The support system need not come only from rehabilitation care providers; larger support networks (eg, friends, family, teammates, care providers, coaches, fans, online support groups) promote positive recovery experiences.…”

Surgical techniques in the management of pediatric anterior cruciate ligament tears: Current concepts

“… 71 , 72 , 76 Another indication for AEAPs in the pediatric setting may be very young children who have a limited rehabilitation capacity and poor neuromuscular control. 77 …”

“…71,72,76 Another indication for AEAPs in the pediatric setting may be very young children who have a limited rehabilitation capacity and poor neuromuscular control. 77 Pediatric cadaveric studies have shown some improvements in translation or rotatory instability with AEAPs but clinical outcome data are lacking in the skeletally immature. 28 The adult literature does support the use of AEAPs with which there has been improved graft failure rates regardless of AEAP method, better outcome scores, and patient satisfaction.…”