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2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries
  1. Clare L Ardern1,2,
  2. Guri Ranum Ekås3,4,5,
  3. Hege Grindem6,
  4. Håvard Moksnes4,
  5. Allen F Anderson7,
  6. Franck Chotel8,
  7. Moises Cohen9,
  8. Magnus Forssblad10,
  9. Theodore J Ganley11,
  10. Julian A Feller12,13,
  11. Jón Karlsson14,
  12. Minider S Kocher15,16,
  13. Robert F LaPrade17,18,
  14. Michael McNamee19,
  15. Bert Mandelbaum20,
  16. Lyle Micheli15,16,21,
  17. Nicholas Mohtadi22,
  18. Bruce Reider23,
  19. Justin Roe24,
  20. Romain Seil25,26,
  21. Rainer Siebold27,28,
  22. Holly J Silvers-Granelli29,
  23. Torbjørn Soligard30,31,
  24. Erik Witvrouw32,
  25. Lars Engebretsen3,4,5,30
  1. 1 Division of Physiotherapy, Linköping University, Linköping, Sweden
  2. 2 School of Allied Health, La Trobe University, Melbourne, Australia
  3. 3 Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
  4. 4 Oslo Sports Trauma Research Centre (OSTRC), Norwegian School of Sport Sciences, Oslo, Norway
  5. 5 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  6. 6 Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  7. 7 Tennessee Orthopaed Alliance, Nashville, Tennessee, USA
  8. 8 Department of Pediatric Orthopaedic Surgery, Hôpital Femme Mere Enfant, Lyon, France
  9. 9 Orthopedic Department, Universidade Federal de São Paulo, São Paulo, Brazil
  10. 10 Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden
  11. 11 Department of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, USA
  12. 12 OrthoSport Victoria Research Unit, Epworth Healthcare, Melbourne, Australia
  13. 13 College of Science, Health & Engineering, La Trobe University, Melbourne, Australia
  14. 14 Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  15. 15 Division of Sports Medicine, Boston Children’s Hospital, Boston, USA
  16. 16 Harvard Medical School, Boston, USA
  17. 17 Steadman Philippon Research Institute, Vail, USA
  18. 18 The Steadman Clinic, Vail, USA
  19. 19 College of Engineering, Swansea University, Swansea, UK
  20. 20 Santa Monica Orthopaedic and Sports Medicine Group, Los Angeles, USA
  21. 21 The Micheli Center for Sports Injury Prevention, Waltham, USA
  22. 22 University of Calgary Sports Medicine Centre, Calgary, Canada
  23. 23 Department of Orthopaedics and Rehabilitation Medicine, University of Chicago, Chicago, USA
  24. 24 North Sydney Orthopaedic & Sports Medicine Centre, Sydney, Australia
  25. 25 Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg, Luxembourg
  26. 26 Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg
  27. 27 Institute for Anatomy and Cell Biology, Ruprecht-Karls-University, Heidelberg, Germany
  28. 28 HKF International Center for Hip, Knee, Foot Surgery and Sports Traumatology, ATOS Klinik, Heidelberg, Germany
  29. 29 FIFA Medical Center of Excellence, Velocity Physical Therapy, Los Angeles, USA
  30. 30 Medical & Scientific Department, International Olympic Committee, Chateau de Vidy, Lausanne, Switzerland
  31. 31 Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
  32. 32 Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
  1. Correspondence to Dr Clare L Ardern, School of Allied Health, La Trobe University, Melbourne, VIC 3086, Australia; c.ardern{at}latrobe.edu.au

Abstract

In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric ACL injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery & Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions.

  • consensus statement
  • orthopaedics
  • paediatrics
  • knee Acl
  • physiotherapy

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Contributors CLA, GRE, LE, HG and HM made substantial contributions to overall and detailed conception, planning, drafting and critically revising the manuscript. CLA, GRE and HG wrote the first draft. AFA, FC, MC, MF, TJG, JAF, JK, MSK, RFLaP, MMcM, BM, LM, NM, BR, JR, RSe, RSi, HJS-G, TS and EW made substantial contributions to drafting and critically revising the manuscript. LE chaired the Lausanne consensus meeting. CLA co-ordinated and administered the Delphi surveys. CLA, LE and HM constructed the Delphi survey.

  • Funding The IOC funded the consensus meeting, but did not influence the content of this consensus statement.

  • Competing interests MC is a paid consultant for Arthrex. LE is the Head of Scientific Activities in the Medical and Scientific Department of the International Olympic Committee, has received fees for speaking from Smith & Nephew, has received research funding from Biomet and Smith & Nephew, has received funds for an employee from Arthrex and Smith & Nephew, has received royalties or fees for consulting from Arthrex and is an Editor of BJSM. MSK is a paid consultant for Best Doctors, OrthoPediatrics, Össur and Smith & Nephew, receives royalties, financial or material support from OrthoPediatrics, Össur, Saunders/Mosby-Elsevier and Wolters Kluwer Health–Lippincott Williams & Wilkins, is a paid member of the Steadman Philippon Research Institute, Scientific Advisory Committee, and is an unpaid board or committee member of the American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Harvard Medical School, Harvard School of Public Health, Herodicus Society, Pediatric Orthopaedic Society of North America and Pediatric Research in Sports Medicine. RLaP receives royalties from Össur, Arthrex and Smith & Nephew. BR receives royalties from Elsevier, salary from American Journal of Sports Medicine and Orthopaedic Journal of Sports Medicine, and holds stock in Merck and Johnson and Johnson. RSe is an unpaid board member and President of the European Society of Sports Traumatology Knee Surgery and Arthroscopy (ESSKA). TS works as Scientific Manager in the Medical and Scientific Department of the International Olympic Committee.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been updated since it was published Online First. The Competing Interests section has been updated.

  • Presented at This article has been co-published in the Journal of ISAKOS, Orthopaedic Journal of Sports Medicine and Knee Surgery Sports Traumatology Arthroscopy.

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