Early review and assessment in adolescent ACL injuries (a London knee surgeon’s view)

There is overwhelming evidence in the literature that a longer time to ACL reconstruction in adolescent patients results in increase risk of meniscus injury.

This paper in the KSSTA journal by Phillips et al reinforces the point, but adds a 12 week watershed beyond which the risk increases considerably consider in skeletally mature adolescents.

This is the case not only for medial meniscus tears, but also chondral injuries, probably as a result of repeated episodes of pivot subluxation.

The suggestion is that adolescents with ACL injuries should be treated within a reasonable window to reduce the risk of further injury.

In our Imperial series, the time to specialist review in the NHS and surgery was well over this timeframe. This highlights the need for timely diagnosis, MRI scan and referral for adolescents with knee swelling post injury, especially when ACL injury is suspected.

Beyond that, we need dedicated pediatric knee operating lists (and specialsts) so that ACL reconstruction can also be performed in reasonable time.

This is very challenging in the NHS but I am sure all at British Association for Surgery of the Knee and British Orthopaedic Association will be very keen to review policies and UK practice. This will certainly be a topic for discussion at the next Imperial Sports Knee Meeting .