The Pediatric Anterior Cruciate Ligament - evaluation and management strategies

Editor: Shital N Parikh, Professor of Orthopedic Surgery at Cincinnati Children's Hospital Center.

Forewards by Lyle J Micheli and Frank R Noyes.  Published by Springer, the 298pp hardcover book includes 25 Chapters from a strong panel of USA contributors.

The book has been sorely needed because of the paucity of knowledge and lack of consensus about the issues relating to ACL and associated injuries in the skeletally-immature. For 40 years the management of ACL injuries in the child and adolescent has lagged behind that of adults, even after the introduction of arthroscopic methods and the several evolutions in management of the adult with an ACL injury. Although initially it was assumed that most children's ACL injuries were avulsions - the ligament being intact but simply pulled off together with its bony attachment to the femur - it is being increasingly recognised that intrasubstance tear of the ACL is not that uncommon in children. Such injuries even seem to be increasing as children engage more and more in organised sports, and the subject of ACL tear management has moved from obscurity to being a 'hot topic' in orthopaedics.

The book stresses, of course, that the key issue continues to be that children are still growing and that surgical strategies should avoid, or at least minimise, damage to the growth plate or physis. Content includes the radiological and physiological classification systems that help to determine the skeletal and physiological age of the child to assess the probable impact of any such interference.

Chapters cover the history of the earlier open repair procedures,  the subsequent development of extraphyseal stabilisation procedures, progressing to later minimally-invasive transphyseal procedures and right up to the modern shift towards arthroscopic repair when conditions are favourable. There are sections on congenital absence of the ACL, management of concomitant injuries (especially meniscal) and prevention of ACL tears in the young female athlete.