Pediatric ACL Tears: Natural History

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Pediatric Orthopedics

Background:

• Youth sports participation is rising, leading to more anterior cruciate ligament (ACL) tears in skeletally immature individuals.
• Historically, ACL reconstruction was delayed in this group to prevent physeal injury.
• Current evidence supports early ACL reconstruction for some to enable return to activity and prevent secondary damage.

Purpose of the Study:

• To review the natural history of ACL injuries in skeletally immature patients.
• To analyze outcomes of nonoperative management for pediatric ACL tears.

Main Methods:

• Conducted a literature review of studies on pediatric ACL tears and conservative treatment from 1970-2018.
• Utilized PubMed with keywords: "anterior cruciate ligament," "pediatric," "adolescent," "conservative," "nonoperative treatment."
• Applied PRISMA workflow to select relevant, full-text articles.

Main Results:

• Nonoperative ACL treatment frequently resulted in secondary meniscal and cartilage damage.
• Some studies found no difference in secondary injuries between surgical and non-surgical groups, but non-surgical groups often modified activity.
• Active athletes treated nonoperatively showed concerning rates of secondary meniscus injury.

Conclusions:

• Nonoperative ACL tear management can be viable for skeletally immature individuals who adhere to activity restrictions.
• For active young adolescents, nonoperative ACL treatment often leads to secondary knee injuries, potentially causing degeneration and instability.