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

Abstract

Background: Anterior cruciate ligament injury in the child and adolescent patient remains a controversial topic when considering management, especially regarding surgical choices. Treatment variations are seen not just when comparing different countries but also within nations. This arises partly as contemporary treatment is mostly inferred from the adult population who physiologically and in terms of outcomes differ significantly from children. There is an increasing body of evidence for this cohort of patients who have specific challenges and difficulties when determining the optimum treatment. Methods: Within this article, we will summarize the current evidence for surgical management of anterior cruciate ligament injury for the pediatric patient. Results and Conclusions: There remain many controversies and gaps inthe treatment of Paediatric Anterior cruciate ligament reconstruction and this high risk cohort continues to cause difficulty in identifying the best mode of surgical management. Level of evidence: level IV.

Pediatric ACL Reconstruction in Children—An Evaluation of the Transphyseal Technique’s Efficacy and Safety

“…Operative treatment, rather than nonoperative treatment, is considered the standard of care for even the youngest athletes with an ACL injury [13]. Physeal sparing (extraphyseal and all-epiphyseal), partial transphyseal, and transphyseal reconstructions are all acceptable techniques based on the patient's skeletal age, physician preference, and shared decision-making [14].…”

“…Operative intervention, as opposed to nonoperative management, is recognized as the standard of care for even the youngest athletes experiencing an ACL injury [13]. Techniques such as physeal sparing (including extraphyseal and all-epiphyseal approaches), partial transphyseal, and complete transphyseal reconstructions are deemed appropriate based on the patient's skeletal maturity, the surgeon's preference, and the shared decisionmaking [14].…”

Arthroscopic repair of proximal anterior cruciate ligament tears in children and adolescents: A systematic review

“…Careful patient selection is required: males <12 years and females <10 years have higher risk of developing growth disturbance as they are still far from reaching skeletal maturity. 49 , 50 These patients are candidates for physeal-sparing techniques such as repair or physeal-sparing reconstruction. The skeletal age at which a transphyseal reconstruction can be safely performed has yet to be determined, but all techniques still have the potential to cause growth disturbance.…”