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

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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 ACL injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery & 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.

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Most cited references 91

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Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

Amelia J Wiggins, Ravi K Grandhi, Daniel Schneider … (2016)

Injury to the ipsilateral graft used for reconstruction of the anterior cruciate ligament (ACL) or a new injury to the contralateral ACL are disastrous outcomes after successful ACL reconstruction (ACLR), rehabilitation, and return to activity. Studies reporting ACL reinjury rates in younger active populations are emerging in the literature, but these data have not yet been comprehensively synthesized.

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Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play.

Clare L. Ardern, Kate E. Webster, Nicholas F Taylor … (2011)

An athlete's intention to return to sport following anterior cruciate ligament (ACL) injury is a major indication for surgical intervention. The purpose of this review was to determine postoperative return-to-sport outcomes after ACL reconstruction surgery. Meta-analysis and systematic review Electronic databases including Medline, Embase, SPORTDiscus and CINAHL were searched from the earliest possible entry to April 2010. Studies were included that reported the number of patients returning to sports participation following ACL reconstruction surgery. The results were presented using the World Health Organization's International Classification of Functioning, Disability and Health as a framework and combined using proportion meta-analyses. Forty-eight studies evaluating 5770 participants at a mean follow-up of 41.5 months were included for review. Overall, 82% of participants had returned to some kind of sports participation, 63% had returned to their preinjury level of participation, and 44% had returned to competitive sport at final follow-up. Approximately 90% of participants achieved normal or nearly normal knee function when assessed postoperatively using impairment-based outcomes such as laxity and strength, and 85% when using activity-based outcomes such as the International Knee Documentation Committee knee evaluation form. Fear of reinjury was the most common reason cited for a postoperative reduction in or cessation of sports participation. The relatively low rate of return to competitive sport despite the high rates of successful outcome in terms of knee impairment-based function suggests that other factors such as psychological factors may be contributing to return-to-sport outcomes.

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Incidence of Second ACL Injuries 2 Years After Primary ACL Reconstruction and Return to Sport.

Mark Paterno, Mitchell Rauh, Laura Schmitt … (2014)

The incidence of second anterior cruciate ligament (ACL) injuries in the first 12 months after ACL reconstruction (ACLR) and return to sport (RTS) in a young, active population has been reported to be 15 times greater than that in a previously uninjured cohort. There are no reported estimates of whether this high relative rate of injury continues beyond the first year after RTS and ACLR.

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Journal

Journal ID (nlm-ta): Br J Sports Med

Journal ID (iso-abbrev): Br J Sports Med

Journal ID (hwp): bjsports

Journal ID (publisher-id): bjsm

Title: British Journal of Sports Medicine

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Print): 0306-3674

ISSN (Electronic): 1473-0480

Publication date (Print): April 2018

Publication date (Electronic): 24 February 2018

Volume: 52

Issue: 7

Pages: 422-438

Affiliations

[1 ] departmentDivision of Physiotherapy , Linköping University , Linköping, Sweden

[2 ] departmentSchool of Allied Health , La Trobe University , Melbourne, Australia

[3 ] departmentDivision of Orthopaedic Surgery , Oslo University Hospital , Oslo, Norway

[4 ] departmentOslo Sports Trauma Research Centre (OSTRC) , Norwegian School of Sport Sciences , Oslo, Norway

[5 ] departmentInstitute of Clinical Medicine , University of Oslo , Oslo, Norway

[6 ] departmentDepartment of Sports Medicine , Norwegian School of Sport Sciences , Oslo, Norway

[7 ] Tennessee Orthopaed Alliance , Nashville, Tennessee, USA

[8 ] departmentDepartment of Pediatric Orthopaedic Surgery , Hôpital Femme Mere Enfant , Lyon, France

[9 ] departmentOrthopedic Department , Universidade Federal de São Paulo , São Paulo, Brazil

[10 ] departmentStockholm Sports Trauma Research Center , Karolinska Institute , Stockholm, Sweden

[11 ] departmentDepartment of Orthopaedics , Children’s Hospital of Philadelphia , Philadelphia, USA

[12 ] departmentOrthoSport Victoria Research Unit , Epworth Healthcare , Melbourne, Australia

[13 ] departmentCollege of Science, Health & Engineering , La Trobe University , Melbourne, Australia

[14 ] departmentDepartment of Orthopaedics, Sahlgrenska Academy , University of Gothenburg , Gothenburg, Sweden

[15 ] departmentDivision of Sports Medicine , Boston Children’s Hospital , Boston, USA

[16 ] Harvard Medical School , Boston, USA

[17 ] Steadman Philippon Research Institute , Vail, USA

[18 ] The Steadman Clinic , Vail, USA

[19 ] departmentCollege of Engineering , Swansea University , Swansea, UK

[20 ] Santa Monica Orthopaedic and Sports Medicine Group , Los Angeles, USA

[21 ] The Micheli Center for Sports Injury Prevention , Waltham, USA

[22 ] University of Calgary Sports Medicine Centre , Calgary, Canada

[23 ] departmentDepartment of Orthopaedics and Rehabilitation Medicine , University of Chicago , Chicago, USA

[24 ] North Sydney Orthopaedic & Sports Medicine Centre , Sydney, Australia

[25 ] departmentDepartment of Orthopaedic Surgery , Centre Hospitalier Luxembourg , Luxembourg

[26 ] departmentSports Medicine Research Laboratory , Luxembourg Institute of Health , Luxembourg

[27 ] departmentInstitute for Anatomy and Cell Biology , Ruprecht-Karls-University , Heidelberg, Germany

[28 ] departmentHKF International Center for Hip, Knee, Foot Surgery and Sports Traumatology , ATOS Klinik , Heidelberg, Germany

[29 ] departmentFIFA Medical Center of Excellence , Velocity Physical Therapy , Los Angeles, USA

[30 ] departmentMedical & Scientific Department, International Olympic Committee , Chateau de Vidy , Lausanne, Switzerland

[31 ] departmentSport Injury Prevention Research Centre, Faculty of Kinesiology , University of Calgary , Calgary, Alberta, Canada

[32 ] departmentDepartment of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science , Ghent University , Ghent, Belgium

Author notes

[Correspondence to ] Dr Clare L Ardern, School of Allied Health, La Trobe University, Melbourne, VIC 3086, Australia; c.ardern@ 123456latrobe.edu.au

Author information

Clare L Ardern http://orcid.org/0000-0001-8102-3631

Holly J Silvers-Granelli http://orcid.org/0000-0002-8959-9448

Torbjørn Soligard http://orcid.org/0000-0001-8863-4574

Article

Publisher ID: bjsports-2018-099060

DOI: 10.1136/bjsports-2018-099060

PMC ID: 5867447

PubMed ID: 29478021

SO-VID: 4a2b1e9d-508d-439d-82b9-d65ac948e90e

License:

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

History

Date accepted : 23 January 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003965, International Olympic Committee;

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ScienceOpen disciplines: Sports medicine

Keywords: consensus statement,orthopaedics,paediatrics,knee acl,physiotherapy

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ScienceOpen disciplines: Sports medicine

Keywords: consensus statement, orthopaedics, paediatrics, knee acl, physiotherapy

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

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Most cited references 91

Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play.

Incidence of Second ACL Injuries 2 Years After Primary ACL Reconstruction and Return to Sport.

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