Trends in Management and Complications of Anterior Cruciate Ligament Injuries in Pediatric Patients: A Survey of the PRiSM Society

Popkin, Charles A.; Wright, Margaret L.; Pennock, Andrew T.; Vogel, Laura A.; Padaki, Ajay S.; Redler, Lauren H.; Ahmad, Christopher S.

doi:10.1097/bpo.0000000000001098

Cited by 31 publications

(25 citation statements)

References 19 publications

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“…Surgical techniques to address ACL tears in growing children and adolescents have rapidly evolved to minimize the risk of growth disturbance and retear. 4 Addressing the anterolateral complex (ALC) during anterior cruciate ligament reconstruction (ACLR) has recently re-emerged in the literature. The ALC includes several structures: the iliotibial band (ITB), distal and proximal Kaplan's fibers, the anterolateral ligament (ALL), and the capsular attachment of the lateral meniscus.…”

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confidence: 99%

Modified Lemaire Lateral Extra-articular Tenodesis in the Pediatric Patient: An Adjunct to Anterior Cruciate Ligament Reconstruction

Schlichte

Aitchison

Green

et al. 2020

Arthroscopy Techniques

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Recent literature has identified a population of active adolescents aged 13 to 15 years who are at high risk for anterior cruciate ligament graft rupture. Addressing the anterolateral complex during primary anterior cruciate ligament reconstruction has recently re-emerged in the literature, with various techniques available. This paper aims to describe a lateral extra-articular tenodesis procedure using the iliotibial band with a modified Lemaire technique. This procedure is recommended for active adolescents at a high risk of graft re-tear as an enhancement to primary anterior cruciate ligament reconstruction with soft-tissue graft.

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confidence: 99%

Modified Lemaire Lateral Extra-articular Tenodesis in the Pediatric Patient: An Adjunct to Anterior Cruciate Ligament Reconstruction

Schlichte

Aitchison

Green

et al. 2020

Arthroscopy Techniques

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“… 1 , 2 Surgical techniques specific for this skeletally immature population have rapidly evolved to minimize the risk of growth disturbance and retear. 3 However, incidence of graft failure is still high, with reported rates of retear ranging anywhere from 6% to 38%, largely dependent on the age and level of competition within the pediatric and young adolescent cohort as well as the type of graft used. 4 , 5 When performing anterior cruciate ligament reconstruction (ACLR) in a growing adolescent athlete, the common graft options include hamstring tendon autograft versus quadriceps tendon autograft.…”

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confidence: 99%

Open Full-Thickness Quadriceps Tendon Autograft Harvest With Repair for Anterior Cruciate Ligament Reconstruction

Aitchison

Schlichte

Green

et al. 2020

Arthroscopy Techniques

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Historically, one of the most common graft choices for anterior cruciate ligament (ACL) reconstruction in the pediatric population has been the hamstring autograft. Although pediatric ACL reconstructions with a hamstring autograft have allowed a majority of children and adolescents to return to athletics, it has been reported that anywhere between 6% and 38% of these patients will go on to experience subsequent graft rupture. The quadriceps tendon autograft is an alternative to the hamstring tendon autograft that demonstrates superior preliminary outcomes, and we currently recommend it for skeletally immature patients undergoing primary and revision ACL reconstruction. This paper aims to describe our technique for an open full-thickness quadriceps tendon harvest with repair.

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“…37,44 Although historically ACL injuries within this population were treated nonoperatively, recent evidence suggesting higher rates of additional cartilage or meniscal injury 2,22,36 and reduced activity levels within conservatively managed children 36 has led most surgeons within the United States to prefer earlier surgical intervention. 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).…”

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

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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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Trends in Management and Complications of Anterior Cruciate Ligament Injuries in Pediatric Patients: A Survey of the PRiSM Society

Abstract: Level V-survey of expert opinion and experience.

Cited by 31 publications

References 19 publications

Modified Lemaire Lateral Extra-articular Tenodesis in the Pediatric Patient: An Adjunct to Anterior Cruciate Ligament Reconstruction

Modified Lemaire Lateral Extra-articular Tenodesis in the Pediatric Patient: An Adjunct to Anterior Cruciate Ligament Reconstruction

Open Full-Thickness Quadriceps Tendon Autograft Harvest With Repair for Anterior Cruciate Ligament Reconstruction

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

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