Factors Affecting the Preferred Surgical Technique in Pediatric Anterior Cruciate Ligament Reconstruction

BACKGROUND: Despite several well-described operative techniques, the optimal management of anterior cruciate ligament (ACL) injuries in pediatric patients remains unclear. PURPOSE: To identify surgeons’ preferred ACL reconstruction techniques and postoperative protocols for pediatric patients of various ages. STUDY DESIGN: Cross-sectional study. METHODS: An electronic survey was administered to surgeons in the Pediatric Research in Sports Medicine (PRiSM) society, resulting in a cohort of experienced respondents who performed a relatively high volume of ACL reconstructions in skeletally immature patients. Surgeon and practice demographic information was recorded. The survey presented the scenario of a patient who had a physical examination and imaging consistent with an acute, isolated ACL tear. The respondents were asked to select their preferred reconstruction technique for female and male patients at consecutive skeletal ages from 8 to 15 years. Surgeons were also asked about postoperative protocol. RESULTS: Of 103 surgeons, 88 (85%) responded to the survey, the majority of whom (68%) performed more than 25 pediatric ACL reconstructions annually. The greatest variation in technique was from ages 11 to 13 years in female patients and from 11 to 14 years in male patients. The modified MacIntosh was the most frequently used technique for patients aged 8 to 10 years. An all-epiphyseal technique was preferred over a broader age range in male patients than female patients, with peak use at age 11 in both. A partial transphyseal (hybrid) technique was preferred in slightly older patients, with peak use at age 12 in female patients and 13 in male patients. The transphyseal technique was most widely used at age 13 and older in female patients and 14 and older in male patients. The impact of fellowship training (pediatrics, sports, or both) on technique preference was statistically significant for male patients aged 11 to 13 and female patients 11 and 12 (all P < .05). Surgeons with pediatric orthopaedic training tended to prefer an all-epiphyseal reconstruction, while those with both pediatric and sports medicine training preferred the modified MacIntosh. CONCLUSION: The preferred ACL reconstruction technique varied considerably, especially for patients aged 11 to 13 years. The modified MacIntosh reconstruction was favored in patients aged 10 years or younger, while the transphyseal technique was preferred in female patients aged 13 years and older and in male patients 14 years and older. The surgeon’s fellowship training was significantly associated with his or her preferred surgical technique.