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Wait and see approach may prove best for most pediatric ACL injuries
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TORONTO — Orthopaedic surgeons need structured guidance in the management of ACL injuries in children due to their high prevalence and numerous factors to consider, according to a speaker here at the International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine Congress.
“There is no international consensus [on treatment of ACL tears in children], which we are discussing at an international level, to get the expert opinions,” Romain Seil, MD, secretary general of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy, said.
Romaine Seil
He and others worldwide seek to establish the Pediatric ACL Monitoring Initiative, the first step which will be to survey surgeons to determine their current practices for treating torn ACLs in children. The diverse treatment approaches surgeons worldwide now use indicate the need for such a consensus and there is scant information to guide treatment now, including limited epidemiological data, Seil said.
Although “children’s ACL injuries account for about 45% of all ACL injuries,” many physiological and pathological issues are poorly understood in these patients, he said. The extreme laxity, high-risk valgus landings and rapid lower extremity growth in children of as much as 2 cm per year present a host of problems and variables in the management of pediatric ACL injuries.
“Personally, I do not do an early ACL reconstruction. I explain to my patients and to their parents — and start rehabilitation to treat these lesions in children and try and limit their physical activity if possible, and use close follow-up,” Seil said.
He noted that Lars Engebretsen, MD, PhD, of Oslo, Norway, another proponent of nonoperative treatment in these children and one who insists on a as long as possible follow-up, gets a high rate of return to sports. Other investigators have reported success rates of 42% with conservative treatment of pediatric ACL injuries, he said. Seil sometimes uses bracing, but said “this is, in some cases, is a limited option.”
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If operative management is indicated, he said to have a preoperative plan, avoid using transphyseal hardware or bone blocks, select a 6-mm to 8-mm graft for transphyseal procedures and use physeal-sparing distal fixation.
Reference:
Seil R. Pediatric ACL injuries. Presented at: The International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine Congress; May 12-16, 2013; Toronto.
Disclosure: Seil has no relevant financial disclosures.