From the Guidelines
Treatment options for Anterior Cruciate Ligament (ACL) tears in pediatric patients typically involve rehabilitation after ACL reconstruction, with a focus on immediate knee mobilisation and strength/neuromuscular training.
Key Components of Rehabilitation
- Immediate knee mobilisation to increase joint range of motion, reduce knee pain, and prevent soft tissue-related adverse events 1
- Strength/neuromuscular training, including isometric quadriceps strengthening exercises, concentric and eccentric exercises, and neuromuscular and motor control re-education exercises 1
- Early full weight-bearing exercises, progressed as tolerated, to promote recovery and reduce the risk of complications 1
- Cryotherapy and neuromuscular electrostimulation may be used in the initial postoperative period to reduce knee pain and promote quadriceps strength, respectively 1
Rehabilitation Protocol
- Initiate isometric quadriceps strengthening exercises from the first postoperative week, if not causing pain, and progress to concentric and eccentric exercises 1
- Prioritize closed kinetic chain exercises in the first postoperative month to mitigate the risk of patellofemoral pain, and add open kinetic chain exercises as early as 4 weeks 1
- Consider supervised home-based rehabilitation in highly motivated patients to augment strength training and promote recovery 1
From the Research
Treatment Options for Anterior Cruciate Ligament (ACL) Tears in Pediatric Patients
- The treatment options for pediatric and adolescent anterior cruciate ligament (ACL) injuries include early operative, delayed operative, and nonoperative management 2, 3, 4.
- Early operative treatment is favored over delayed or nonoperative treatment, as it results in fewer meniscal tears and higher return-to-sport rates 2, 3.
- Nonoperative management is associated with high rates of residual knee instability, increased risk of meniscal tears, and low rates of return to sports 2, 3.
- Delaying ACL reconstruction in pediatric or adolescent patients for more than 12 weeks significantly increases the risk of meniscal injuries and irreparable meniscal tears 2.
Surgical Techniques
- Physeal-sparing reconstruction with an iliotibial band graft is proposed for type III and IV ACL tears 5.
- Primary ACL repair is proposed for type I and II ACL tears with remaining good tissue quality 5.
- The treatment algorithm should be based on skeletal development, ACL tear location, type, and quality, as well as parental perspective 5.
Risks and Complications
- Operative reconstruction carries the concern for damage to the physis with resultant limb length inequality and angular joint deformity 4, 6.
- Nonoperative treatment has been shown to carry an increased risk of meniscal and articular cartilage damage 4, 6.
- The risk of growth disturbance is minimal with operative treatment, and it has shown good clinical and functional results 4.