Related Experiment Video
Updated: Feb 28, 2026
Author Spotlight: Implementing the Enhanced Recovery After Surgery Concept in Rehabilitation Following Anterior Cruciate Ligament Reconstruction
Published on: March 1, 2024
The Paediatric ACL National Audit (PANA) study: a multicentre review of UK practice and adherence to BOAST guidelines
Benjamin D Gompels1, Alagu Subramanian1, Ilias E Epanomeritakis1
1University of Cambridge, Department of Surgery, Division of Trauma and Orthopaedic Surgery, Box 180 Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom.
Insights
Paediatric anterior cruciate ligament (ACL) injuries are rising, with a UK audit showing varied adherence to best practice guidelines. Standardised care and a multidisciplinary approach are crucial for improving outcomes in young patients.
Area of Science:
- Orthopaedic surgery
- Paediatric sports medicine
- Clinical audit
Background:
- Paediatric anterior cruciate ligament (ACL) injuries are a growing concern, with improper management leading to long-term issues.
- The Paediatric ACL National Audit (PANA) Study aims to evaluate current UK practices for managing these injuries.
Purpose of the Study:
- To assess UK centres' adherence to Best Orthopaedic Practice (BOAST) guidelines for paediatric ACL injuries.
- To identify areas for improvement in the care pathway for young patients with ACL injuries.
Main Methods:
- A collaborative audit involving 22 UK hospitals.
- Data collected via online questionnaires from orthopaedic surgeons and trainees.
- Focus on service provision for skeletally immature patients, including diagnostics, rehabilitation, and surgical techniques.
Main Results:
- Significant variability in adherence to BOAST guidelines across centres.
- While many centres use specific pathways for acute injuries and imaging, fewer report functional outcomes or re-rupture rates.
- Adherence to rehabilitation protocols is higher, but overall guideline compliance shows room for improvement.
Conclusions:
- The increasing incidence of paediatric ACL injuries necessitates standardized care.
- The PANA study highlights discrepancies in UK practice post-BOAST guideline release.
- A multidisciplinary approach is vital to standardize best practices and enhance patient outcomes.
Background:
Paediatric ACL injuries are increasingly common and present significant challenges. Inappropriate treatment can lead to long-term complications like instability, growth disturbance, and osteoarthritis. The Paediatric ACL National Audit (PANA) Study assesses UK practices and adherence to Best Orthopaedic Practice (BOAST) guidelines for managing these injuries, identifying opportunities to improve care for young patients.
Methods:
PANA was a collaborative audit of 22 hospitals in England, Wales, and Scotland, measuring adherence to BOAST guidelines in treating paediatric ACL injuries. Orthopaedic surgeons and trainees collected data through a secure online questionnaire about service provision for skeletally immature patients, including diagnostic imaging, rehabilitation, post-operative follow-up, and surgical techniques.
Results:
Our analysis revealed variability in adherence to the BOAST guidelines for ACL injuries in paediatric patients, with 65% of centres using acute knee pathways and 68% utilising collaborative imaging pathways. About 59% of centres conduct radiological growth monitoring, while only 30% report functional outcomes. Less than 50% report re-rupture rates, and 74% adhere to rehabilitation protocols.
Conclusion:
The rise in ACL injuries in the paediatric population highlights the need for standardised care delivery and reporting. Following the release of the BOAST guidelines in 2022, this nationwide audit has revealed discrepancies in UK practices. A multidisciplinary approach is essential for improving patient care and outcomes by standardising and promoting best practice.
Related Concept Videos
01:19Standards of Care II
01:22Standards of Care I
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management