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. 2018 Apr;26(4):989-1010.
doi: 10.1007/s00167-018-4865-y. Epub 2018 Feb 17.

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

Clare L Ardern  1   2 , Guri Ekås  3   4   5 , Hege Grindem  6 , Håvard Moksnes  4 , Allen Anderson, Franck Chotel  7 , Moises Cohen  8 , Magnus Forssblad  9 , Theodore J Ganley  10 , Julian A Feller  11   12 , Jón Karlsson  13 , Mininder S Kocher  14   15 , Robert F LaPrade  16   17 , Mike McNamee  18 , Bert Mandelbaum  19 , Lyle Micheli  14   15   20 , Nicholas Mohtadi  21 , Bruce Reider  22 , Justin Roe  23 , Romain Seil  24   25 , Rainer Siebold  26   27 , Holly J Silvers-Granelli  28 , Torbjørn Soligard  29   30 , Erik Witvrouw  31 , Lars Engebretsen  3   4   5   29
Affiliations

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

Clare L Ardern et al. Knee Surg Sports Traumatol Arthrosc. 2018 Apr.

Abstract

In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric anterior cruciate ligament (ACL) injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery and 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. 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. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis, and management of paediatric ACL injuries. The aim of this consensus statement is 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.

Keywords: ACL; Anterior cruciate ligament; Child; Consensus; Knee; Orthopaedics; Paediatric.

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Conflict of interest statement

Conflict of interest

MC is a paid consultant for Arthrex. LE is the Head of Scientific Activities in the Medical and Scientific Department of the International Olympic Committee, has received research funding from Biomet and Smith & Nephew, has received funds for an employee from Arthrex and Smith & Nephew, and has received royalties or fees for consulting from Arthrex. JK is the Editor-in-Chief of Knee Surgery Sports Traumatology Arthroscopy. MSK is a paid consultant for Best Doctors, OrthoPediatrics, Össur and Smith & Nephew, receives royalties, financial or material support from OrthoPediatrics, Össur, Saunders/Mosby-Elsevier and Wolters Kluwer Health–Lippincott Williams & Wilkins, is a paid member of the Steadman Philippon Research Institute–Scientific Advisory Committee, and is an unpaid board or committee member of the American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Harvard Medical School, Harvard School of Public Health, Herodicus Society, Pediatric Orthopaedic Society of North America and Pediatric Research in Sports Medicine. RLaP receives royalties from Össur, Arthrex and Smith & Nephew. BR receives royalties from Elsevier, salary from American Journal of Sports Medicine and Orthopaedic Journal of Sports Medicine, and holds stock in Merck and Johnson and Johnson. RSe is an unpaid board member and President of the European Society of Sports Traumatology Knee Surgery and Arthroscopy (ESSKA). TS works as Scientific Manager in the Medical and Scientific Department of the International Olympic Committee.

Ethical approval

This consensus statement did not involve collection or analysis of patient data. Ethical approval was not sought nor required.

Informed consent

For this type of article, formal consent is not required.

This article has been co-published in the Journal of ISAKOS, Orthopaedic Journal of Sports Medicine and British Journal of Sports Medicine.

Figures

Fig. 1
Fig. 1
Injury prevention exercises incorporated into team training
Fig. 2
Fig. 2
Child demonstrating how to hold terminal knee extension during single limb stance. This is an important marker of quadriceps control in ACL rehabilitation and prehabilitation
Fig. 3
Fig. 3
One example of an exercise that could be incorporated into a home-based ACL rehabilitation program
Fig. 4
Fig. 4
Transphyseal ACL reconstruction (anterior and lateral views)
Fig. 5
Fig. 5
Physeal-sparing ACL reconstruction using an over-the-top technique with iliotibial band (anterior and lateral views)
Fig. 6
Fig. 6
Physeal-sparing ACL reconstruction using an all-epiphyseal technique (anterior and lateral views)
Fig. 7
Fig. 7
Partial transphyseal ACL reconstruction (anterior, lateral and posterior views)
Fig. 8
Fig. 8
Three options for femoral tunnel trajectories
Fig. 9
Fig. 9
Three growth disturbances that may occur following ACL reconstruction. “p” represents the physiological growth process; dashed lines represent the physiological growth arrest lines; continuous lines represent the observed pathological growth arrest line. Type A (Arrest): growth arrest process (a) occurs after a localised injury of the physis and results in a bone bridge across the physis. The extent of deformity is proportional to the location and size of the initial physeal injury. Type B (Boost): overgrowth process (p+) is probably caused by local hypervascularisation, stimulating the open physis (b). This growth disturbance is temporary and usually becomes apparent in a limited period of 2 years following ACL reconstruction. It primarily leads to leg length discrepancy. Type C (deCelerate): undergrowth process (indicated by p−) due to a tenoepiphysiodesis effect. The graft tension across the open physis causes the deformity. Adapted from [22]
Fig. 10
Fig. 10
Appearance of the highly vascular paediatric meniscus on MRI. 10-year-old boy, 3.0T MRI (Signa HDxt 3.0-T; GE Medical Systems)
See this image and copyright information in PMC

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