To survey and describe the treatment of paediatric anterior cruciate ligament (ACL) injuries performed by orthopaedic surgeons affiliated with the European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).
A closed e-survey was submitted to all registered members and affiliates of ESSKA in July 2013. All recipients were invited to participate in the survey by answering 34 questions online. The list of potential respondents was extracted from the ESSKA office database.
Invitation was sent to 2236 ESSKA members and affiliates, and received 491 (22 %) unique responses. Among the respondents, 445 (91 %) were orthopaedic surgeons, with 354 (72 %) stating that they were involved in treatment of paediatric ACL injuries. The main findings were that there are substantial differences with regard to preferred treatment algorithms, surgical techniques and long-term follow-up procedures. The summed estimate of skeletally immature children with ACL injury seen by the responders in 2012 was minimum 1923 individuals, and a minimum of 102 clinically relevant post-operative growth disturbances were registered.
The present survey documents that the incidences of paediatric ACL injuries and idiopathic growth disturbances may be higher than previously estimated. Treatment algorithms and surgical techniques are highly diverse, and consensus could not be identified. It is worrying that only half the surgeons reported to follow-up children until skeletal maturity after surgical treatment. The results of this survey highlight the importance of international multicentre studies on paediatric ACL treatment and the development of an outcome registry to enable prospective data collections.
Level of evidence
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Anderson AF, Anderson CN (2015) Correlation of meniscal and articular cartilage injuries in children and adolescents with timing of anterior cruciate ligament reconstruction. Am J Sports Med 43(2):275–281
Bollen S, Pease F, Ehrenraich A, Church S, Skinner J, Williams A (2008) Changes in the four-strand hamstring graft in anterior cruciate ligament reconstruction in the skeletally-immature knee. J Bone Joint Surg Br 90(4):455–459
Caine D, DiFiori J, Maffulli N (2006) Physeal injuries in children’s and youth sports: reasons for concern? Br J Sports Med 40(9):749–760
Calvo R, Figueroa D, Gili F, Vaisman A, Mococain P, Espinosa M, Leon A, Arellano S (2015) Transphyseal anterior cruciate ligament reconstruction in patients with open physes: 10-year follow-up study. Am J Sports Med 43(2):289–294
Chotel F, Henry J, Seil R, Chouteau J, Moyen B, Berard J (2010) Growth disturbances without growth arrest after ACL reconstruction in children. Knee Surg Sports Traumatol Arthrosc 18(11):1496–1500
Chotel F, Seil R (2013) Growth disturbances after transphyseal ACL reconstruction in skeletally immature patients: who is more at risk? Young child or adolescent? J Pediatr Orthop 33(5):585–586
Demange MK, Camanho GL (2014) Nonanatomic anterior cruciate ligament reconstruction with double-stranded semitendinosus grafts in children with open physes: minimum 15-year follow-up. Am J Sports Med 42(12):2926–2932
Eitzen I, Holm I, Risberg MA (2009) Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction. Br J Sports Med 43(5):371–376
Engebretsen L, Steffen K, Bahr R, Broderick C, Dvorak J, Janarv PM, Johnson A, Leglise M, Mamisch TC, McKay D, Micheli L, Schamasch P, Singh GD, Stafford DE, Steen H (2010) The international olympic committee consensus statement on age determination in high-level young athletes. Br J Sports Med 44(7):476–484
Eysenbach G (2004) Improving the quality of web surveys: the checklist for reporting results of internet e-surveys (CHERRIES). J Med Internet Res 6(3):e34
Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam J, Lohmander LS (2013) Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ 346:f232
Frosch KH, Stengel D, Brodhun T, Stietencron I, Holsten D, Jung C, Reister D, Voigt C, Niemeyer P, Maier M, Hertel P, Jagodzinski M, Lill H (2010) Outcomes and risks of operative treatment of rupture of the anterior cruciate ligament in children and adolescents. Arthroscopy 26(11):1539–1550
Funahashi KM, Moksnes H, Maletis GB, Csintalan RP, Inacio MC, Funahashi TT (2014) Anterior cruciate ligament injuries in adolescents with open physis: effect of recurrent injury and surgical delay on meniscal and cartilage injuries. Am J Sports Med 42(5):1068–1073
Granan LP, Bahr R, Steindal K, Furnes O, Engebretsen L (2008) Development of a national cruciate ligament surgery registry: the Norwegian national knee ligament registry. Am J Sports Med 36(2):308–315
Grindem H, Eitzen I, Engebretsen L, Snyder-Mackler L, Risberg MA (2014) Nonsurgical or surgical treatment of ACL injuries: knee function, sports participation, and knee reinjury: The Delaware-Oslo ACL cohort study. J Bone Joint Surg Am 96(15):1233–1241
Grindem H, Eitzen I, Snyder-Mackler L, Risberg MA (2014) Online registration of monthly sports participation after anterior cruciate ligament injury: a reliability and validity study. Br J Sports Med 48(9):748–753
Henry J, Chotel F, Chouteau J, Fessy MH, Berard J, Moyen B (2009) Rupture of the anterior cruciate ligament in children: early reconstruction with open physes or delayed reconstruction to skeletal maturity? Knee Surg Sports Traumatol Arthrosc 17(7):748–755
Hettrich CM, Dunn WR, Reinke EK, Spindler KP (2013) The rate of subsequent surgery and predictors after anterior cruciate ligament reconstruction: two- and 6-year follow-up results from a multicenter cohort. Am J Sports Med 41(7):1534–1540
Hildebrandt C, Muller L, Zisch B, Huber R, Fink C, Raschner C (2015) Functional assessments for decision-making regarding return to sports following ACL reconstruction. Part I: development of a new test battery. Knee Surg Sports Traumatol Arthrosc 23(5):1273–1281
Iversen MD, Lee B, Connell P, Andersen J, Anderson AF, Kocher MS (2010) Validity and comprehensibility of the international knee documentation committee subjective knee evaluation form in children. Scand J Med Sci Sports 20(1):e87–e95
Kaeding CC, Aros B, Pedroza A, Pifel E, Amendola A, Andrish JT, Dunn WR, Marx RG, McCarty EC, Parker RD, Wright RW, Spindler KP (2011) Allograft versus autograft anterior cruciate ligament reconstruction: predictors of failure from a moon prospective longitudinal cohort. Sports Health 3(1):73–81
Kaeding CC, Flanigan D, Donaldson C (2010) Surgical techniques and outcomes after anterior cruciate ligament reconstruction in preadolescent patients. Arthroscopy 26(11):1530–1538
Kocher MS, Saxon HS, Hovis WD, Hawkins RJ (2002) Management and complications of anterior cruciate ligament injuries in skeletally immature patients: survey of the Herodicus society and the ACL study group. J Pediatr Orthop 22(4):452–457
Kocher MS, Smith JT, Iversen MD, Brustowicz K, Ogunwole O, Andersen J, Yoo WJ, McFeely ED, Anderson AF, Zurakowski D (2011) Reliability, validity, and responsiveness of a modified international knee documentation committee subjective knee form (Pedi-IKDC) in children with knee disorders. Am J Sports Med 39(5):933–939
Kruse LM, Gray B, Wright RW (2012) Rehabilitation after anterior cruciate ligament reconstruction: a systematic review. J Bone Joint Surg Am 94(19):1737–1748
Kumar S, Ahearne D, Hunt DM (2013) Transphyseal anterior cruciate ligament reconstruction in the skeletally immature: follow-up to a minimum of sixteen years of age. J Bone Joint Surg Am 95(1):e1
Kvist J, Kartus J, Karlsson J, Forssblad M (2014) Results from the Swedish national anterior cruciate ligament register. Arthroscopy 30(7):803–810
Lawrence JT, Argawal N, Ganley TJ (2011) Degeneration of the knee joint in skeletally immature patients with a diagnosis of an anterior cruciate ligament tear: is there harm in delay of treatment? Am J Sports Med 39(12):2582–2587
Lawrence JT, Bowers AL, Belding J, Cody SR, Ganley TJ (2010) All-epiphyseal anterior cruciate ligament reconstruction in skeletally immature patients. Clin Orthop Relat Res 468(7):1971–1977
Lee K, Siegel MJ, Lau DM, Hildebolt CF, Matava MJ (1999) Anterior cruciate ligament tears: mR imaging-based diagnosis in a pediatric population. Radiology 213(3):697–704
Lynch AD, Logerstedt DS, Grindem H, Eitzen I, Hicks GE, Axe MJ, Engebretsen L, Risberg MA, Snyder-Mackler L (2015) Consensus criteria for defining ‘successful outcome’ after ACL injury and reconstruction: a Delaware-Oslo ACL cohort investigation. Br J Sports Med 49(5):335–342
Magnussen RA, Trojani C, Granan LP, Neyret P, Colombet P, Engebretsen L, Wright RW, Kaeding CC, Group M, Group SFARA (2015) Patient demographics and surgical characteristics in ACL revision: a comparison of French, Norwegian, and North American cohorts. Knee Surg Sports Traumatol Arthrosc 23(8):2339–2348
Mohtadi N, Grant J (2006) Managing anterior cruciate ligament deficiency in the skeletally immature individual: a systematic review of the literature. Clin J Sport Med 16(6):457–464
Moksnes H, Engebretsen L, Eitzen I, Risberg MA (2013) Functional outcomes following a non-operative treatment algorithm for anterior cruciate ligament injuries in skeletally immature children 12 years and younger. A prospective cohort with 2 years follow-up. Br J Sports Med 47(8):488–494
Moksnes H, Engebretsen L, Risberg MA (2012) The current evidence for treatment of ACL injuries in children is low: a systematic review. J Bone Joint Surg Am 94(12):1112–1119
Moksnes H, Engebretsen L, Risberg MA (2013) Prevalence and incidence of new meniscus and cartilage injuries after a nonoperative treatment algorithm for ACL tears in skeletally immature children: a prospective MRI study. Am J Sport Med 41(8):1771–1779
Ortqvist M, Iversen MD, Janarv PM, Brostrom EW, Roos EM (2014) Psychometric properties of the knee injury and osteoarthritis outcome score for children (KOOS-Child) in children with knee disorders. Br J Sports Med 48(19):1437–1446
Ortqvist M, Roos EM, Brostrom EW, Janarv PM, Iversen MD (2012) Development of the knee injury and osteoarthritis outcome score for children (KOOS-Child): comprehensibility and content validity. Acta Orthop 83(6):666–673
Park SY, Oh H, Park S, Lee JH, Lee SH, Yoon KH (2013) Factors predicting hamstring tendon autograft diameters and resulting failure rates after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 21(5):1111–1118
Reider B (2015) A matter of timing. Am J Sport Med 43(2):273–274
Robert H, Bonnard C (1999) The possibilities of using the patellar tendon in the treatment of anterior cruciate ligament tears in children. Arthroscopy 15(1):73–76
Robert HE, Casin C (2010) Valgus and flexion deformity after reconstruction of the anterior cruciate ligament in a skeletally immature patient. Knee Surg Sports Traumatol Arthrosc 18(10):1369–1373
Seil R, Pape D, Kohn D (2008) The risk of growth changes during transphyseal drilling in sheep with open physes. Arthroscopy 24(7):824–833
Sled EA, Sheehy LM, Felson DT, Costigan PA, Lam M, Cooke TD (2011) Reliability of lower limb alignment measures using an established landmark-based method with a customized computer software program. Rheumatol Int 31(1):71–77
Yoo WJ, Kocher MS, Micheli LJ (2011) Growth plate disturbance after transphyseal reconstruction of the anterior cruciate ligament in skeletally immature adolescent patients: an MR imaging study. J Pediatr Orthop 31(6):691–696
About this article
Cite this article
Moksnes, H., Engebretsen, L. & Seil, R. The ESSKA paediatric anterior cruciate ligament monitoring initiative. Knee Surg Sports Traumatol Arthrosc 24, 680–687 (2016). https://doi.org/10.1007/s00167-015-3746-x
- Growth disturbances