🎯 Título: Consenso de expertos sobre lesión de LCA en niños (APKASS 2024)
📌 En breve: Un panel de 23 cirujanos expertos de Asia-Pacífico logró consenso sobre varios aspectos del manejo de la lesión de LCA en niños y adolescentes, aunque persisten desacuerdos sobre técnica quirúrgica y tipo de injerto.
🔬 Puntos clave:
### Qué es este documento
Es un documento de consenso de expertos (no un estudio con datos de pacientes): 23 cirujanos de 8 países debatieron nueve áreas clave del manejo de la lesión de LCA pediátrica, considerando consenso cuando al menos el 75% coincidía en una postura.
### Dónde hubo acuerdo
Hubo fuerte consenso en implementar programas de prevención de lesiones en deportes de alto riesgo (85%) y en evaluar sistemáticamente lesiones asociadas de menisco o cartílago antes de decidir la cirugía (91,3%). También hubo consenso en monitorear rutinariamente alteraciones del crecimiento tras la cirugía y en usar un enfoque de múltiples criterios para autorizar el retorno al deporte.
### Dónde NO hubo acuerdo
No hubo consenso sobre la técnica quirúrgica óptima en pacientes con esqueleto inmaduro ni sobre el diámetro ideal del injerto. El 78,3% de los cirujanos prefirió decisiones caso por caso en lugar de un protocolo único.
🎯 Aplicación clínica para LATAM: Cirujanos ortopédicos pediátricos de la región pueden usar este consenso como referencia, sabiendo que en varios aspectos técnicos (injerto, técnica quirúrgica) la decisión debe individualizarse según cada paciente, no seguir un protocolo rígido.
⚠ Limitaciones: Es un documento de consenso basado en opinión experta (nivel de evidencia V, el más bajo), no en datos de pacientes o ensayos clínicos.
Background
The greater training load and early specialization in youth sports has led to an alarming increase in knee injuries, particularly anterior cruciate ligament (ACL) injuries among children and adolescents. This study aimed to develop a consensus among surgeons and experts from the Asia-Pacific Knee, Arthroscopy and Sports Medicine Society (APKASS) on key aspects of paediatric ACL injury management to enhance clinical outcomes.
Methods
Twenty-three expert surgeons from 8 countries participated in the consensus meeting, which focused on nine crucial domains: prevention, diagnosis, management, surgical techniques, post-operative care, management of associated injuries, rehabilitation, outcome evaluation, and future directions. A predefined agreement threshold of 75% was used to determine consensus. Responses were analysed alongside current literature to pinpoint areas of agreement and divergence.
Results
The consensus project revealed strong agreement on several key aspects of paediatric ACL injury management, particularly the implementation of injury prevention programmes for high-risk sports (85%) and the importance of assessing concomitant meniscal or chondral injuries for surgical intervention (91.3%). However, significant variability was observed in areas such as diagnostic challenges, treatment timing, and rehabilitation protocols. There was no consensus on optimal surgical techniques for skeletally immature patients or the ideal graft diameter for reconstruction. Individualized treatment approaches were emphasized, with 78.3% of surgeons advocating for case-by-case decision-making, reflecting the need to consider factors like skeletal maturity, activity level, and family preferences. There was also a strong consensus on the need for routine monitoring of growth disturbances post-surgery and a comprehensive multi-criteria approach for return-to-sport assessments, underscoring the complexity of managing paediatric ACL injuries.
Conclusion
This expert consensus, developed from an Asia-Pacific perspective, showed both agreement and variation in managing paediatric ACL injuries. While strong consensus was achieved on diagnostic and immediate post-injury care, differences remained in surgical timing, graft selection, and rehabilitation. These findings highlight the need for region specific and paediatric focused guidelines to optimise long term outcomes and establish standardised evaluation criteria for this unique population.
Level of evidence
V (Expert opinion).
Cómo citar:
Wang M, Hoshino Y, Moatshe G, Wang JH, Issaragrisil P, Mogos S, Saengpetch N, Phornphutkul C, Kim JG, Kuroda R, Kulkamthorn N, Koga H, Otsuki S, Akagi R, Lee SH, Eriksson K, Yoon KH, Chernchujit B, Ke (2026).
APKASS 2024 consensus statement on anterior cruciate ligament reconstruction, Part I: Management of paediatric anterior cruciate ligament injury.. Asia-Pacific journal of sports medicine, arthroscopy, rehabilitation and technology.
DOI: 10.1016/j.asmart.2026.05.007 ↗ PMID: 42291753 ↗ Acceso al paper: Ver completo ↗
