Physician Preferences on Bone Age Determination for Anterior Cruciate Ligament (ACL) Reconstructions for Pediatric Patients with Acl Injuries

INTRODUCTION: The frequency of anterior cruciate ligament (ACL) injuries is increasing in pediatric and adolescent patients. Currently, there is no standardized skeletal maturity determination for pediatric and adolescent patients that present with an ACL tear. HYPOTHESIS/PURPOSE: This study aims to evaluate physicians’ preferences for obtaining bone age studies for pediatric and adolescent patients with an ACL injury. METHODS: A survey link was sent to the members of Pediatric Research in Sports Medicine (PRiSM). Participation in the survey was voluntary. Consent was obtained by the participants taking part in the survey. RESULTS: Forty-five physician responses were included in this analysis. Seven were female, thirty-six male, and one preferred not to answer. Twenty physicians had completed a pediatric orthopaedic fellowship, six had completed a sports medicine fellowship, and nineteen had completed both. Thirty-five respondents reported that greater than 75% of their patients were 18 years old or younger. When asked about the number of ACL reconstructions performed each year on skeletally immature patients, 15.6% (n=7) report less than 5, 11.1% (n=5) said 5-9, 44.4% (n=20) said 10-34, 20.0% (n=9) report 35-49, and 8.9% (n=4) said they perform 50 or more. A majority of the participants (n=32) said that they routinely obtain a skeletal age study. Of the participants that routinely order a skeletal age study, 100% (n=32) get a bone age for patients 11 and 12 years old. Seventeen (n=17) obtain a bone age study for patients 8-14 years of age. When asked about bone age determination method, 100% (n=45) said one method they use is hand bone age and twenty-four (n=24) only use hand bone age. Thirty-four (n=34) report they sometimes see a significant difference (2 or more years) between bone age radiographs and chronological age while eleven (n=11) report they almost never see a significant difference. Thirty-one report that a patient’s skeletal age sometimes changes their technique or graft preference. CONCLUSION: Results of this survey suggest that bone age studies are used to treat pediatric and adolescent patients with ACL injuries. Hand bone age, in particular the Greulich-Pyle method, is the most widely used among the respondents. Obtaining bone age radiographs can help physicians to formulate a proper treatment plan for their patients. Further research is needed to identify the true impact of bone age studies on the treatment of ACL injuries in pediatric and adolescent patients.