January 2018

ACL treatment in children varies widely; 90% return to sport after ACLR

In the moment: Sports medicine

iStockphoto.com 171577005

By Nicole Wetsman

Over the past 15 years, the incidence of anterior cruciate ligament (ACL) injury in children and adolescents has increased. And although this population requires special considerations, in part due to their continued musculoskeletal growth, medical management of this condition varies widely. Toward this end, 71 orthopedic members of the Pediatric Research in Sports Medicine (PRiSM) study group were surveyed to assess their medical management recommendations and associated complications in pediatric ACL injury. The study was published in the February 2018 issue of the Journal of Pediatric Orthopaedics.

For the 15-question survey, two scenarios were presented: an 8-year-old child with a complete ACL tear and adolescent patients with 2 years of growth remaining. Regarding the child, iliotibial band reconstruction was recommended by 53% of respondents; all-epiphyseal reconstruction was recommended by 33%; but only 3% recommended bracing over a surgical intervention. For adolescent patients, physeal “respecting” technique was recommend by 47% of respondents; physeal sparing intervention was recommended by 31%; and 19% indicated they would perform an adult-style ACL reconstruction (ACLR). Additionally, whereas growth disturbance after ACLR remains low, new cases continue to be reported.

In a related topic, a study published in the January 2018 issue of Knee Surgery, Sports Traumatology, Arthroscopy indicates that more than 90% of children and adolescents return to sport after undergoing ACLR. The researchers reviewed 20 studies comprising 1,156 ACLR cases that met the inclusion criteria. The cohort had a mean age of 14.3 years, with a mean follow-up time of 6.5 years. The rate of return to sport was 92% and the rate of return to preinjury level of sport was 78.6%. On final follow-up, however, it was noted that this return to sport was associated with a relatively high rate of reinjury, with graft rupture and contralateral ACL injury.

Sources:

Popkin CA, Wright ML, Pennock AT, Vogel LA, et al. Trends in management and complications of anterior cruciate ligament injuries in pediatric patients: a survey of the PRiSM Society. J Pediatr Orthop. 2018;38(2):e61-e65.

Kay J, Memon M, Marx RG, et al. Over 90% of children and adolescents return to sport after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2018 Jan 13. [Epub ahead of print]

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