Rehabilitation Following Anterior Cruciate Ligament Tears in Children

Yellin, Joseph L.; Fabricant, Peter D.; Gornitzky, Alex L.; Greenberg, Elliot; Conrad, Sara K.; Dyke, Julie; Ganley, Theodore J.

doi:10.2106/jbjs.rvw.o.00001

Cited by 41 publications

(31 citation statements)

References 76 publications

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“… 19 , 25 Newer, milestone-based postoperative rehabilitation programs also account for the variable neuromuscular development in young athletes. 49 Considerable debate regarding the optimal treatment strategies in this population persists and has resulted in heightened study of clinical outcomes among children and adolescents undergoing ACL reconstruction procedures. Ongoing clinical outcomes research is needed to delineate the indications for and outcomes associated with the treatment options currently in practice.…”

mentioning

confidence: 99%

Clinical Outcome Reporting in Youth ACL Literature Is Widely Variable

Brusalis

Lakomkin

Suryavanshi

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Advances in anterior cruciate ligament (ACL) reconstruction procedures in pediatric and adolescent patients have resulted in an increase in recent clinical studies on this topic. However, the consistency with which outcome measures are reported in this demographic is unknown.Purpose:To document outcome reporting patterns of youth ACL reconstruction studies in high-impact journals.Study Design:Systematic review; Level of evidence, 4.Methods:All articles published in 5 high-impact orthopaedic journals from 2010 to 2016 were reviewed to identify those reporting clinical outcomes of young patients who underwent ACL reconstruction. Studies that were nonclinical, reported on patients older than 18 years, or included fewer than 10 patients were excluded. Outcome measures used in all included studies were recorded.Results:Seventeen studies encompassing 772 subjects (mean age, 14.3 years; range, 6.3-18.0 years) were analyzed. Eight studies (47%) reported on Tanner stage of subjects, while 1 study reported skeletal age. Ten studies (59%) clearly documented the presence or absence of surgical complications. Range of motion was reported in 65% of studies. Leg-length discrepancy and angular deformity were each reported in 76% of studies, with 12% quantifying results through radiographic measurements. Ligament testing was variably defined by inclusion of instrumented testing (65%), Lachman test (53%), and pivot-shift test (53%). Fourteen studies (82%) explicitly reported on the rate of ACL rerupture, while 71% reported on the rate of revision surgery. Rate of return to preinjury activity was reported in 8 studies (47%), of which 2 defined criteria for return to sport and 3 defined the level of competitive sport. Patient-reported outcome measures (PROMs) were used variably. For the 3 most commonly reported PROMs (Lysholm, International Knee Documentation Committee, and Tegner), 24% of studies reported all 3 PROMs, 35% of studies reported 2 PROMs, and 6% of studies reported 1 PROM in isolation. A pediatric-specific PROM was reported in 1 of the 17 studies.Conclusion:Studies on pediatric ACL reconstruction published in high-impact journals unreliably defined subjects’ skeletal maturity, inconsistently reported on objective outcome measures, and used disparate adult-validated PROMs to assess subjective outcomes. These findings highlight the need for standardized, pediatric-specific outcome measures to be applied in future studies evaluating ACL reconstruction in children and adolescents.

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mentioning

confidence: 99%

Clinical Outcome Reporting in Youth ACL Literature Is Widely Variable

Brusalis

Lakomkin

Suryavanshi

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…The standard of ≥90% LSI is of particular interest within the skeletally immature youth population, as this demographic demonstrates increasing frequency of ACL injuries 5,10,28 and only a limited pool of performance-related outcomes research exists. While many published protocols specifically designed to be employed with skeletally immature athletes require LSI values of ≥90%, 46 our results indicate that the majority of healthy athletes are unable to perform at these standards on the complete test battery. Interestingly, the level of performance within this healthy cohort is similar to published values within patients after ACLR.…”

Section: Discussionmentioning

confidence: 60%

“…29,35,41 Current postoperative rehabilitation guidelines emphasize strength and functional performance testing to assist in the determination of recovery and ability to safely return to sports. 46 Since being introduced in the early 1990s, the battery of single-leg hop tests (SLHTs) described by Barber et al 3 and Noyes et al 32 has become one of the most widely utilized functional performance tests after ACL reconstruction (ACLR). 1,12,13 This test battery consists of 4 different single-leg hopping activities, and the patient’s performance is compared between the uninvolved and involved limbs to calculate a limb symmetry index (LSI).…”

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confidence: 99%

Uninjured Youth Athlete Performance on Single-Leg Hop Testing: How Many Can Achieve Recommended Return-to-Sport Criterion?

et al. 2020

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Background: Current anterior cruciate ligament reconstruction (ACLR) guidelines utilize single-leg hop tests (SLHTs) to assist in return-to-sport decision making. A limb symmetry index (LSI) of ≥90% is often required; however, after ACLR, most youth athletes cannot achieve this standard. Reporting the performance of age-matched normative controls will allow clinicians to compare post-ACLR performance with noninjured peers, improving the utility of SLHTs. The purpose of this study was to report hop test LSI within healthy youth athletes and determine whether athlete performance surpasses post-ACLR requirements. Hypothesis: The LSI for the majority of healthy youth athletes will be ≥90%. Study Design: Cross-sectional cohort study. Level of Evidence: Level 3. Methods: Each participant performed a single hop (SH), triple hop (TrH), crossover hop (CrH), and timed hop (TiH). A 3-trial mean was utilized to calculate an LSI (nondominant/dominant leg [self-reported kicking leg]) for each hop. The frequency of pass/fail at ≥90% LSI was calculated. Pearson correlation coefficients analyzed the relationship between the different hops, and a 2-way analysis of variance determined the effects of age and sex on LSI. Results: A total of 340 participants (54% male; mean age, 10.9 ± 1.5 years; range, 8-14 years) were included. The mean LSI was >95% for each SLHT (SH, 97.9% [SD, 0.7]; TrH, 96.6% [SD, 0.6]; CrH, 96.8% [SD, 0.8]; TiH, 96.5% [SD, 0.6]). When analyzed as a test battery, only 45% of participants achieved this standard. Significantly weak to moderate correlations existed among hop tests ( P < 0.01; r = 0.342-0.520). Age and sex had no effect on LSI ( P < 0.05). Conclusion: While the mean LSI in our sample was >95% for each individual hop test, participant performance across all SLHT components varied, such that less than half of healthy athletes could achieve ≥90% LSI across all hops. Clinical Relevance: Current guidelines require ≥90% LSI on SLHTs. The majority of healthy youth athletes could not achieve this standard, which questions the validity of this LSI threshold in youth athletes after ACLR.

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“…Guidance for paediatric rehabilitation is extrapolated from clinical experience and research in adults, although it is uncertain whether adult principles apply to children 28. Paediatric rehabilitation must be performed in close collaboration with the child’s parents/guardians.…”

Section: Consensus Methodsmentioning

confidence: 99%

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

et al. 2018

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In October 2017, the International Olympic Committee (IOC) hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric ACL injuries. The purpose of this consensus statement was to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery & Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America, and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. This consensus statement addresses 6 fundamental clinical questions regarding the prevention, diagnosis, and management of paediatric ACL injuries. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury.

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Rehabilitation Following Anterior Cruciate Ligament Tears in Children

Cited by 41 publications

References 76 publications

Clinical Outcome Reporting in Youth ACL Literature Is Widely Variable

Clinical Outcome Reporting in Youth ACL Literature Is Widely Variable

Uninjured Youth Athlete Performance on Single-Leg Hop Testing: How Many Can Achieve Recommended Return-to-Sport Criterion?

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

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