APKASS 2024 consensus statement on anterior cruciate ligament reconstruction, Part I: Management of paediatric anterior cruciate ligament injury

Abstract

Background: The greater training load and early specialization in youth sports has led to an alarming increase in knee injuries, particularly anterior cruciate ligament (ACL) injuries among children and adolescents. This study aimed to develop a consensus among surgeons and experts from the Asia-Pacific Knee, Arthroscopy and Sports Medicine Society (APKASS) on key aspects of paediatric ACL injury management to enhance clinical outcomes. Methods: Twenty-three expert surgeons from 8 countries participated in the consensus meeting, which focused on nine crucial domains: prevention, diagnosis, management, surgical techniques, post-operative care, management of associated injuries, rehabilitation, outcome evaluation, and future directions. A predefined agreement threshold of 75% was used to determine consensus. Responses were analysed alongside current literature to pinpoint areas of agreement and divergence. Results: The consensus project revealed strong agreement on several key aspects of paediatric ACL injury management, particularly the implementation of injury prevention programmes for high-risk sports (85%) and the importance of assessing concomitant meniscal or chondral injuries for surgical intervention (91.3%). However, significant variability was observed in areas such as diagnostic challenges, treatment timing, and rehabilitation protocols. There was no consensus on optimal surgical techniques for skeletally immature patients or the ideal graft diameter for reconstruction. Individualized treatment approaches were emphasized, with 78.3% of surgeons advocating for case-by-case decision-making, reflecting the need to consider factors like skeletal maturity, activity level, and family preferences. There was also a strong consensus on the need for routine monitoring of growth disturbances post-surgery and a comprehensive multi-criteria approach for return-to-sport assessments, underscoring the complexity of managing paediatric ACL injuries. Conclusion: This expert consensus, developed from an Asia-Pacific perspective, showed both agreement and variation in managing paediatric ACL injuries. While strong consensus was achieved on diagnostic and immediate post-injury care, differences remained in surgical timing, graft selection, and rehabilitation. These findings highlight the need for region specific and paediatric focused guidelines to optimise long term outcomes and establish standardised evaluation criteria for this unique population. Level of evidence: V (Expert opinion).