Descriptive Epidemiology of Complete ACL Tears in the Skeletally Immature Population: A Prospective Multicenter PLUTO Study.

BACKGROUND

Anterior cruciate ligament (ACL) injuries are common in pediatric and adolescent patients. Understanding this population's injury characteristics and treatment strategies is vital for managing this high-risk group.

PURPOSE: To report the descriptive epidemiology and treatment strategies of a large cohort of skeletally immature patients with complete ACL tears.

STUDY

DESIGN

Cross-sectional study; Level of evidence, 2.

METHODS

Consecutive skeletally immature patients diagnosed with complete ACL tears were enrolled at 10 institutions across the United States. Treatment was provided by 1 of 23 participating orthopaedic surgeons. Patient characteristics (chronological and skeletal age, sex, race, and ethnicity) as well as anthropometric measures, mechanism of injury, and ACL treatment type were collected.

RESULTS

A total of 749 skeletally immature participants were included in the final cohort; the mean chronological age was 12.9 years, and 62% were male. The mean skeletal age (13.2 years) was a mean of 0.34 years (4 months) higher than the mean chronological age (P < .001). Tanner staging revealed that 18% of participants were Tanner stage 1, 20% were Tanner stage 2, 28% were Tanner stage 3, 30% were Tanner stage 4, and 4% were Tanner stage 5. Five percent of participants reported a previous ipsilateral knee injury, and 30% had a family history of ACL injuries. Sport was the predominant mechanism of injury (89%), with noncontact injuries the most common (64%). The most common sport resulting in an ACL tear among boys was American football (41%) and among girls was soccer (44%). Overall, 99.9% of skeletally immature patients were treated surgically by 1 of 4 reconstruction techniques: transphyseal (53%), partial transphyseal (7%), physeal-sparing all-epiphyseal (13%), and physeal-sparing iliotibial band (ITB) (27%). The most common surgical techniques for patients with a skeletal age <13 years were physeal sparing with ITB (56%) and all-epiphyseal (22%), while in patients with a skeletal age ≥13 years, transphyseal (71%) and physeal sparing with ITB (12%) were the most common. Overall, 57% of patients who underwent ACL reconstruction had arthroscopically documented meniscal tears, with high rates of meniscal repair (90% medial tears and 66% lateral tears).

CONCLUSION

Almost all skeletally immature patients with ACL tears were injured during sports, surgical treatment was overwhelmingly the treatment of choice, and preferred surgical techniques varied based on skeletal ages.