Expert Consensus
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2022; 13(9): 777-790
Published online Sep 18, 2022. doi: 10.5312/wjo.v13.i9.777
Consensus Delphi study on guidelines for the assessment of anterior cruciate ligament injuries in children
Angélica Campón Chekroun, Jorge Velázquez-Saornil, Isabel Guillén Vicente, Zacarías Sánchez Milá, David Rodríguez-Sanz, Carlos Romero-Morales, Tomas Fernandez-Jaén, José Ignacio Garrido González, Miguel Ángel Sánchez-Garrido, Pedro Guillén García
Angélica Campón Chekroun, Campus San Jerónimo Guadalupe, Universidad Católica de Murcia, Murcia 30107, Murcia, Spain
Jorge Velázquez-Saornil, Zacarías Sánchez Milá, Department of Physiotherapy, Universidad Católica de Ávila, Ávila 05005, Ávila, Spain
Isabel Guillén Vicente, Tomas Fernandez-Jaén, Pedro Guillén García, Department of Orthopaedic and Trauma Surgery, Clínica Cemtro, Madrid 28035, Madrid, Spain
David Rodríguez-Sanz, Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid 28040, Madrid, Spain
Carlos Romero-Morales, Department of Physical Therapy, Universidad Europea de Madrid, Madrid 28023, Madrid, Spain
José Ignacio Garrido González, Miguel Ángel Sánchez-Garrido, Department of Orthopaedic and Trauma Surgery, Gabinete Médico Garrido, Salamanca 37003, Salamanca, Spain
Author contributions: Campón-Chekroun A and Guillén Vicente I contributed to conceptualization; Velázquez-Saornil J and Sánchez-Milá Z contributed to methodology; Sánchez-Milá Z contributed to software; Velázquez-Saornil J, Rodríguez-Sanz D and Campón-Chekroun A contributed to validation; Romero-Morales C and Rodríguez-Sanz D contributed to formal analysis; Velázquez-Saornil J and Sánchez-Milá Z contributed to investigation; Guillén-García P contributed to resources; Velázquez-Saornil J contributed to data curation; Velázquez-Saornil J contributed to writing—original draft preparation; Velázquez-Saornil J, Fernández-Jaén T contributed to writing—review and editing; Garrido-González JI and Sánchez-Garrido MÁ contributed to visualization; Guillén-García P contributed to supervision; Guillén-García P and Guillén Vicente I contributed to project administration; All authors have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jorge Velázquez-Saornil, PhD, Physiotherapist, Professor, Department of Physiotherapy, Universidad Católica de Ávila, C/ Canteros s/n, Ávila 05005, Ávila, Spain. jorge.velazquezsaornil@ucavila.es
Received: March 11, 2022
Peer-review started: March 11, 2022
First decision: June 8, 2022
Revised: June 16, 2022
Accepted: August 17, 2022
Article in press: August 17, 2022
Published online: September 18, 2022
Abstract

Background: Knee examination guidelines in minors are intended to aid decision-making in the management of knee instability. Clinical question: A Delphi study was conducted with a formal consensus process using a validated methodology with sufficient scientific evidence. A group consensus meeting was held to develop recommendations and practical guidelines for use in the assessment of instability injuries in children. Key findings: there is a lack of evidence to analyse anterior cruciate ligament injuries in children and their subsequent surgical management if necessary. Diagnostic guidelines and clinical assessment of the patient based on a thorough examination of the knee are performed and a guide to anterior cruciate ligament exploration in children is developed. Clinical application: In the absence of a strong evidence base, these established guidelines are intended to assist in that decision-making process to help the clinician decide on the most optimal treatment with the aim of benefiting the patient as much as possible. Following this expert consensus, surgical treatment is advised when the patient has a subjective sensation of instability accompanied by a pivot shift test ++, and may include an anterior drawer test + and a Lachman test +. If these conditions are not present, the conservative approach should be chosen, as the anatomical and functional development of children, together with a physiotherapy programme, may improve the evolution of the injury.

Keywords: Anterior cruciate ligament, Diagnoses and examinations, Sports injuries, Knee, Injury to minors

Core Tip: A Delphi study was conducted with a formal consensus process using validated methodology with scientific evidence to develop recommendations and practical guidelines for the assessment of instability injuries in children. Following this expert consensus, surgical treatment is advised when the patient has a subjective sensation of instability accompanied by a pivot shift test ++, and may include an anterior drawer test + and a Lachman test +. If these conditions are not present, the conservative approach should be chosen, as the anatomical and functional development of children, together with a physiotherapy programme, may improve the evolution of the injury.