Towards Standardization in the Diagnostic Evaluation of ACL Injuries in Skeletally Immature Patients

The purpose of this study was to establish consensus regarding a standardized approach to the diagnostic evaluation of ACL tears in pediatric/adolescent patients. Despite an abundance of literature evaluating management techniques, no standardized consensus exists regarding evaluation in these patients. A three-step classic Delphi technique was employed. The panel included 12 Orthopaedic Sports Medicine specialists from across the United States with training in pediatric and adult ACL injuries. Panelists were presented with four clinical vignettes. Consensus was established if ≥66% of respondents reached agreement. Across all four rounds of this study, 100% participation was achieved, and consensus was reached for a majority of diagnostic domains. For history, previous injuries, sports participation, and current symptoms were endorsed for all vignettes. The consensus radiographic sequences across all four vignettes included: standing AP, flexion (tunnel or notch view), lateral, long-leg alignment, and bone age (left hand) views. Radiographic interpretation responses met consensus with interpretations were split by gender. Cross-sectional imaging met consensus with 100% support for MRI. In this Delphi study, we identified a standardized diagnostic treatment approach derived from expert opinion applicable to all skeletally immature patients with ACL tears, which can serve as a framework for evaluation to aid clinical decision making.