Warning published RE: ACL repair (as opposed to reconstruction) in children.

Guidelines have recently been released by the BASK (British Association for Surgery of the Knee) / BSCOS (British Society for Children’s Orthopaedic Surgery) Steering Committee on the Paediatric Knee:

https://www.bscos.org.uk/Committees/Committees/knee.php

There has recently been some controversy with respect to the potential best management of ACL tears in the paediatric population. It is generally accepted that early ACL reconstruction is usually the best and most appropriate treatment for ACL tears in children, to stabilise the joint and to try and minimise as much as possible the adverse effects of ACL-deficiency in the knee. Over recent years, however, some surgeons have been promoting the technique of ACL repair (where the ligament is stitched back to the bone) instead of ACL reconstruction (where the torn ligament is replaced with a new tendon/ligament: a graft). The outcomes of ACL reconstruction are tried and tested, with many years’ worth of results published. ACL repair, however, is a newer concept with considerably less evidence to support its use.

The BASK/BSCOS Steering Committee has reviewed the published evidence and has now made specific recommendations, advising on standards for UK surgery to promote safe, effective practice.

Specifically with respect to ACL repair vs reconstruction, the guidance states the following:

• Contemporary ACL repair is unproven in children as of yet and cannot be recommended as a routine treatment for ACL tears… In the absence of a significant body of evidence in support of its use… Patients and their carers should be carefully counselled that the gold standard operative treatment for ACL tears is reconstruction.”

For further information about the issue of ACL repair vs ACL reconstruction, please read:

https://sportsortho.co.uk/blog/research-watch-acl-repair-vs-reconstruction/

Mr Ian McDermott, 24th Jan 2021