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Treatment of Concomitant Pathology During ACL Reconstruction

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The Pediatric Anterior Cruciate Ligament

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Abstract

As the incidence of ACL injuries in children continues to rise, fastest in adolescents between 10 and 14 years of age, orthopedic surgeons need to be prepared to manage the concomitant pathology associated with these injuries and understand the changing trends in the care of these patients. The reason for the growing number of injuries is multifactorial and likely related to increased intensity of sports participation and early sports specialization.

Over half of all ACL injuries in children will be accompanied by additional injuries. The most common are tears of the meniscus, articular cartilage lesions, or additional knee ligament injuries. Many concomitant injuries occur at the time of the initial insult. However, many others develop secondary to altered joint mechanics in the setting of intra-articular derangement and chronic knee instability. In the initial evaluation of an ACL injury, additional pathology should be sought with a high index of suspicion, as there is a high incidence of repairable injuries. Careful history and physical examination should be carried out to search for additional injuries or risk factors for injuries, such as hemarthrosis, higher BMI, and delayed presentation.

While the proper timing of ACL reconstruction has historically been controversial due to concerns about disrupting the physis in a young patient, there is a clear trend towards earlier treatment in order to identify treatable concomitant injuries early in the patient’s course and to prevent additional injuries that may result from chronic knee instability.

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Abbreviations

ACI:

Autologous chondrocyte implantation

ACL:

Anterior cruciate ligament

ACL reconstruction:

Anterior cruciate ligament reconstruction

BMI:

Body Mass Index

IKDC:

International Knee Documentation Committee

KOOS:

Knee Injury and Osteoarthritis Outcome Score

MCL:

Medial collateral ligament

MRI:

Magnetic resonance imaging

OAT:

Osteochondral autologous transfer

OATM:

Osteochondral autologous transfer/mosaicplasty

PCL:

Posterior cruciate ligament

ROM:

Range of motion

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Authors and Affiliations

  1. The Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia, PA, 19104, USA

    Taylor Jackson B.A. & Theodore J. Ganley M.D.

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  1. Taylor Jackson B.A.
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  2. Theodore J. Ganley M.D.
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Correspondence to Theodore J. Ganley M.D. .

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  1. Cincinnati Children’s Hospital, Cincinnati, Ohio, USA

    Shital N. Parikh

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Jackson, T., Ganley, T.J. (2018). Treatment of Concomitant Pathology During ACL Reconstruction. In: Parikh, S. (eds) The Pediatric Anterior Cruciate Ligament. Springer, Cham. https://doi.org/10.1007/978-3-319-64771-5_17

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  • DOI: https://doi.org/10.1007/978-3-319-64771-5_17

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