Pediatric ACL: Understanding Treatment Options

Anterior Cruciate Ligament (ACL) injuries are being seen with increased frequency in
pediatric and adolescent patients. The management of these injuries is controversial and
includes nonoperative treatment and operative treatment with various surgical techniques.
Pediatric ACL: Understanding Treatment Outcomes (PLUTO) is a multi-center, prospective cohort
study. Specific aims of PLUTO are to evaluate the safety and comparative effectiveness of
non-operative treatment, as well as four operative treatments including (1) transphyseal ACL
reconstruction (2) partial transphyseal ACL reconstruction, (3) physeal-sparing epiphyseal
ACL reconstruction using the Anderson technique, and (4) physeal-sparing ACL reconstruction
using the Micheli/Kocher technique in prepubescent and pubescent skeletally immature
patients. Accrual will take place over eight years at 9 pediatric sports medicine centers.
Post-treatment outcome assessment will be performed at 6-9 months, 1 year, and 2, 5, and 10
years after treatment , including functional outcome, activity level, health-related quality
of life, graft survivorship, knee stability, knee motion, and growth disturbance.

Inclusion Criteria:

- Diagnosis of complete intrasubstance ACL tear

- Skeletally Immature (by knee radiographs)

Exclusion Criteria:

- Prior ACL surgery on the ipsilateral knee

- Congenital ACL deficiency

- Multiple ligament reconstruction required

- Other significant comorbidities including syndromic conditions, neuromuscular
disorders or developmental delay

- If scheduling of the ACL surgery is impacted by the skeletal maturity of the patient

- Simultaneous bilateral ACL tears