Anterior cruciate ligament tears in children: Management and growth disturbances. A survey of French Arthroscopy Society members.

BACKGROUND: Anterior cruciate ligament (ACL) tears are becoming more common and occurring at earlier ages in the paediatric population. The surgical indications and the optimal time for surgery, technique, and graft type remain controversial in skeletally immature patients. Growth disturbances have been reported after ACL reconstruction, further complicating treatment decisions. The primary objective of this study was to describe current practices of French Arthroscopy Society (Société Francophone d'Arthroscopie, SFA) members regarding ACL tear management in skeletally immature patients. The secondary objectives were to determine the incidence, type, and severity of growth disturbances after ACL reconstruction.

HYPOTHESIS: Recent publications support early surgical reconstruction and the further development of transphyseal techniques, even in pre-pubertal patients.

MATERIAL AND METHODS: An email invitation to complete a 52-item questionnaire was sent to all SFA members. Participation was voluntary and replies were kept confidential. The data were collected automatically via the SurveyMonkey® tool. Descriptive statistics were computed.

RESULTS: Of 1280 invited SFA members, 142 replied, yielding a participation rate of 11%. Among respondents, 14% recommended ACL reconstruction within 3 months for pre-pubertal patients, compared to 35% for pubertal paediatric patients. The preferred tibial tunnel was transphyseal for both pre-pubertal patients (44.4% of respondents) and pubertal patients (97.7% of respondents). The preferred femoral tunnel was epiphyseal for pre-pubertal patients (62.2% of respondents) and transphyseal for pubertal patients (55.5% of respondents). Growth disturbances after ACL reconstruction were reported by 7% of respondents.

CONCLUSION: No consensus exists to date about the surgical management of ACL tears in skeletally immature patients. Transphyseal tunnels are gaining in popularity, even for pre-pubertal children. Reports of significant growth disturbances, although relatively rare, warrant the implementation of technical precautions.

LEVEL OF EVIDENCE: IV, descriptive epidemiological survey.