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Pediatric Anterior Cruciate Ligament Tears: Epidemiology, Evaluation, and Evolving Treatment Strategies

DOI- https://doi.org/10.13107/ijpo.2025.v11.i02.226

Open Access License: CC BY-NC 4.0

Submitted: 01/06/2025; Reviewed: 30/06/2025; Accepted: 06/07/2025; Published: 10/08/2025

Authors: Doria L. Weiss BS [1] , Alexis Carr BS [1], Kevin Berardino MD [1], Kevin Quindlen MD [1], Rachel Talley-Bruns MD [1]

[1] Westchester Medical Center, Department of Orthopaedic Surgery, Valhalla, NY

Address of Correspondence

Dr. Doria L. Weiss,
Westchester Medical Center, Department of Orthopaedic Surgery, Valhalla, NY.
E-mail: dweiss23@student.nymc.edu

Abstract

Introduction: Anterior cruciate ligament (ACL) tears in pediatric patients are increasingly recognized due to rising sports participation and improved imaging. Given the presence of open physes, treatment decisions must balance the need for knee stability with the risk of growth disturbance. This review outlines current approaches to diagnosis, surgical techniques, graft selection, postoperative rehabilitation, and complications in skeletally immature patients.
Methods: This review summarizes recent literature on pediatric ACL injuries, including epidemiology, injury patterns, surgical management strategies, graft options, rehabilitation protocols, and complication rates. Emphasis is placed on the rationale behind technique selection based on skeletal maturity and long-term outcomes.
Results: Surgical reconstruction has become the preferred treatment for most pediatric ACL injuries to prevent secondary damage and restore knee stability. Several physeal-sparing and transphyseal techniques are available, with selection guided by skeletal age and growth remaining. All-epiphyseal and extraphyseal techniques avoid crossing the physis, while transphyseal reconstruction is safe in adolescents nearing skeletal maturity. Hamstring and quadriceps tendon autografts are most commonly used, while bone–patellar tendon–bone grafts and allografts are generally avoided in younger patients. Graft failure and growth disturbance remain key concerns, with retear rates reaching up to 20% and growth abnormalities occurring in 1–5% of cases. Rehabilitation protocols are evolving toward milestone-based progression, with return to sport typically delayed at least 12 months. However, re-injury rates remain high in this population.
Conclusions: ACL injuries in pediatric patients require a nuanced, age-specific approach. Surgical reconstruction using physeal-respecting or transphyseal techniques offers favorable outcomes when matched to skeletal maturity. Careful graft selection, individualized rehabilitation, and delayed return to sport are essential to optimize results and reduce complications. Ongoing research is needed to refine surgical strategies, compare graft types, and establish evidence-based rehabilitation and return-to-sport guidelines.
Keywords: Paediatrics, Anterior Cruciate Ligament Tears, Epidemiology, Evaluation, Evolving Treatment Strategies

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How to Cite this Article: Weiss DL, Carr A, Berardino K, Quindlen K, Bruns RT. Paediatric Anterior Cruciate Ligament Tears: Epidemiology, Evaluation, and Evolving Treatment Strategies. International Journal of Paediatric Orthopaedics . May-August 2025; 11(2): 02-10.

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Editorial

Volume 11 | Issue 1 | January-April 2025 | Page: 01 | Jayanth S. Sampath

DOI- https://doi.org/10.13107/ijpo.2025.v11.i01.210

Authors: Jayanth S. Sampath FRCSEd (Tr & Orth) [1]

[1] Department of Orthopaedics, Rainbow Children’s Hospital, Bangalore, Karnataka, India.

Address of Correspondence

Dr. Jayanth S. Sampath,
Rainbow Children’s Hospital, Bangalore, Karnataka, India.
E-mail: editor.posi.ijpo@gmail.com

Editorial

The management of skeletal dysplasias in children has transformed in recent years thanks to widespread availability of genetic studies in the developing world and a better understanding of the orthopaedic aspects of these complex multi-system problems. It has become a common experience for orthopaedic surgeons to be presented with a genetic report that lists an obscure skeletal dysplasia. This issue of IJPO is aimed to improve the awareness among orthopaedic surgeons of the common skeletal dysplasias, their typical clinical and radiological features, and management.
We present an overview of the principles and practice of orthopaedic surgery in skeletal dysplasias. The issue kicks off with an introduction by Dr Sukalyan Dey and colleagues regarding the definition and classification of skeletal dysplasias. Dr Sangeet Gangadharan follows with a comprehensive outline of the radiological diagnosis and the need for specialised investigations. Dr Arjun Dhawale and co-workers have provided a broad perspective to the assessment and treatment of spinal disorders. The role of growth modulation in deformities around the knee has been covered in detail with case examples by Dr Akash Kumar Ghosh. Our associate editor, Dr Gaurav Garg has pitched in with an excellent overview of hip problems in skeletal dysplasias. Dr Binu Kurian has detailed the management of limb deformities, an article co-authored by Dr James Fernandes from Sheffield Children’s Hospital, a world authority on the subject.
We are proud that the authors are from institutions across the world, each offering a unique perspective to the management of these difficult problems. Please share the articles with your trainees and fellows. IJPO issues are easily downloadable free of charge and in full-text format from our website www.ijpoonline.com
We invite your suggestions and comments for any improvements to the journal. Kindly write to us editor.ijpo@gmail.com or editor@posi.org.in
It is my pleasure to acknowledge the contributions of authors, reviewers, editors, and the backend team who have been instrumental in bringing out this issue. We acknowledge Dr Easwar T Ramani, POSI Webmaster for the cover page artwork which adds interest to the contents of this issue.

Sincerely

Dr Jayanth S Sampath
Editor,
International Journal of Paediatric Orthopaedics

How to Cite this Article: Sampat JS | Editorial | International Journal of Paediatric Orthopaedics | May-August 2025;11(1): 01. https://doi.org/10.13107/ijpo.2025.v11.i01.210

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Management of Deformities Around the Knee in Skeletal Dysplasia and a Review of Current Literature on Guided Growth in Skeletal Dysplasia

Volume 11 | Issue 1 | Januar-April 2025 | Page: 25-33 | Akash Kumar Ghosh, Puneeth K Pai, Vikas Ellur

DOI- https://doi.org/10.13107/ijpo.2025.v11.i01.218

Open Access License: CC BY-NC 4.0

Submitted: 14/02/2025; Reviewed: 26/02/2025; Accepted: 02/04/2025; Published: 10/04/2025

Authors: Akash Kumar Ghosh M.Ch (Paed. Ortho.) [1], Puneeth K Pai MS Ortho [1], Vikas Ellur MS Ortho [1]

[1] Department of Orthopaedics, Paediatric Orthopaedics Unit, Narayana Healthcity, Bengaluru, Karnataka, India.

Address of Correspondence

Dr. Akash Kumar Ghosh,
Department of Orthopaedics, Paediatric Orthopaedics Unit, Narayana Healthcity, Bengaluru, Karnataka, India.
E-mail: akashgh994@gmail.com

Abstract

Skeletal dysplasias are a heterogeneous group of disorders characterized by abnormal bone and cartilage formation, often presenting with complex lower limb deformities, particularly around the knee. This review provides a comprehensive overview of the current evidence regarding the management of knee deformities in skeletal dysplasias.
Deformities may arise due to asymmetric physeal. involvement, unequal growth of paired bones, or soft tissue contractures. A thorough history, comprehensive examination, and appropriate imaging are, essential for accurate assessment. Instrumented gait analysis provides valuable insights into the dynamic impact of deformities.
Treatment planning should consider the multifocal and multiplanar nature of deformities, unpredictable growth patterns, bone quality, and anesthetic risks. Guided growth is a safe and effective option for correcting coronal and sagittal plane deformities in children with at least two years of growth remaining. Acute correction using osteotomies and internal fixation is preferred when the center of rotation of angulation (CORA) is further from the physis. Gradual correction using external fixators is useful for multiplanar and multifocal deformities with limb length discrepancy. A multidisciplinary collaboration and astute planning are important for ensuring optimal outcomes in the management of knee deformities in skeletal dysplasias.
Keywords: Bone disease, Developmental, Osteotomy, Growth plate, Epiphysis, Guided growth

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How to Cite this Article: Ghosh A, Pai PK, Ellur V | Management of Deformities Around the Knee in Skeletal Dysplasia and a Review of Current Literature on Guided Growth in Skeletal Dysplasia | International Journal of Paediatric Orthopaedics | January-April 2025; 11(1): 25-33 .

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Management of Paediatric Spinal Pathologies in Skeletal Dysplasia

Volume 11 | Issue 1 | Januar-April 2025 | Page: 17-24 | Arjun Dhawale, Bhushan Sagade, Atif Naseem, Abhay Nene

DOI- https://doi.org/10.13107/ijpo.2025.v11.i01.216

Open Access License: CC BY-NC 4.0

Submitted: 29/01/2025; Reviewed: 13/02/2025; Accepted: 08/03/2025; Published: 10/04/2025

Authors: Arjun Dhawale MS Ortho [1, 2], Bhushan Sagade MS Ortho [1], Atif Naseem MS Ortho [1], Abhay Nene MS Ortho [1, 2]

[1] Department of Orthopaedics, B.J. Wadia Hospital for Children, Parel, Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Girgaon, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Arjun Dhawale,
Department of Orthopaedics , B.J. Wadia Hospital For Children, Parel, Mumbai 400012, Maharashtra, India.
E-mail: arjundhawale@hotmail.com

Abstract

Treatment of spinal deformities in skeletal dysplasia is challenging. There should be a low threshold for imaging the cervical spine for instability at the craniovertebral junction. A thorough evaluation by a multidisciplinary is necessary before deciding upon any surgery. Deformity, spinal stenosis, and neurological deficit can occur. Medical optimization should be considered. Treatment should be tailored to each patient based on the symptoms, signs, the curve magnitude, and overall prognosis of survival in these patients. Implant failure, intraoperative neuromonitoring signal alerts, and junctional kyphosis are common complications . Most literature is based on expert consensus and small series, there are few long-term outcomes studies.
Keywords: Kyphosis, Scoliosis, Craniovertebral instability, Skeletal Dysplasia, Spinal Fusion, Achondroplasia, Mucopolysaccharidosis

References

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How to Cite this Article: Dhawale A, Sagade B, Naseem A, Abhay Nene A. Management of Paediatric Spinal Pathologies in Skeletal Dysplasia. International Journal of Paediatric Orthopaedics. January-April 2025; 11(1): 17-24.

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Skeletal Dysplasia: Introduction, Definition & Classification

Volume 11 | Issue 1 | Januar-April 2025 | Page: 2-5 | Sukalyan Dey, Kashif Akhtar Ahmed, Mudit Shah, Bansi Khaunte, Abhishek Kayal

DOI- https://doi.org/10.13107/ijpo.2025.v11.i01.212

Open Access License: CC BY-NC 4.0

Submitted: 27/01/2025; Reviewed: 10/02/2025; Accepted: 13/03/2025; Published: 10/04/2025

Authors: Sukalyan Dey MS Ortho [1, 2], Kashif Akhtar Ahmed MS Ortho [3], Mudit Shah MS Ortho [4], Bansi Khaunte MS Ortho [5, 6], Abhishek Kayal MS Ortho [7]

[1] Division of Pediatric Orthopaedics, CORAS Pratiksha Hospital, VIP Road , Borbari, Guwahati, 781036, Assam, India.
[2] Superkidz Pediatric Orthopaedics, Trinitas Medharbor, Paramount Square, VIP Road, Borbari, Guwahati -781036, Assam, India.
[3] Department of Orthopaedics, All India Institute of Medical Sciences, Guwahati, Assam, India.
[4] Consultant, Paediatric Orthopedic Surgeon, Mumbai, Maharashtra, India.
[5] Department of Orthopaedics, South Goa District Hospital, Goa.
[6] Paediatric Orthopaedic Surgery Department, Goa Medical College, North Goa District Hospital, Goa.
[7] Department of Orthopaedics, SRCC Children’s Hospital , Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Sukalyan Dey,
Chief Consultant, Division of Pediatric Orthopaedics, CORAS Pratiksha Hospital, VIP Road , Borbari, Guwahati, 781036, Director, Superkidz Pediatric Orthopaedics, Trinitas Medharbor, Paramount Square, VIP Road, Borbari, Guwahati -781036, Assam, India.
E-mail : sukalyan.gmch@gmail.com

Abstract

Skeletal dysplasias comprise a wide-ranging and intricate category of inherited conditions that interfere with the normal formation, growth, and structural upkeep of bones and cartilage. Historically, their rarity and phenotypic heterogeneity have posed significant diagnostic and classification challenges. This article provides a comprehensive overview of the evolution of skeletal dysplasia nosology, tracing its development from Mendelian principles of inheritance to modern molecular taxonomies.
Early nosological frameworks were primarily clinico-radiological; however, the current paradigm emphasizes molecular and functional classification, reflecting the broader trend toward precision medicine. The International Skeletal Dysplasia Society (ISDS) has played a pivotal role in this shift, with its 2023 Nosology incorporating over 750 distinct disorders grouped by genetic and molecular criteria. The adoption of a dyadic taxonomy—linking gene variants with specific phenotypic descriptors—has enhanced clarity and consistency, besides facilitating better interdisciplinary communication among clinicians, radiologists, and geneticists.
While the nosological framework has considerable utility, it must strike a careful equilibrium between conventional terminology and advancing scientific knowledge. Frequently, it retains historical classifications to ensure continuity in clinical practice and maintain practitioner familiarity. The article also discusses the Bone Dysplasia Ontology as a community-driven alternative to static classifications, promoting dynamic and collaborative knowledge curation.
The purpose of nosology in skeletal dysplasia is not only academic but profoundly clinical: to assist in diagnosis, guide genetic testing, and facilitate research into novel disorders and therapies. While a perfect classification system remains elusive, the trajectory of nosological development mirrors the rapid advancements in genomic medicine and reflects a growing commitment to systematic, inclusive, and adaptive frameworks in the study of skeletal disorders
Keywords: Skeletal Dysplasia, Osteochondrodystrophy, Nosology, Bone Dysplasia Ontology

References

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How to Cite this Article: Dey S, Ahmed KA, Shah M, Khaunte B, Kayal A. Skeletal Dysplasia: Introduction, Definition & Classification. International Journal of Paediatric Orthopaedics. January-April 2025; 11(1): 02-05 .

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The Hip in Skeletal Dysplasia: Evaluation & Management

Volume 11 | Issue 1 | Januar-April 2025 | Page: 34-43 | Gaurav Gupta, Easwar T R, Hitesh Shah, Mohan V Belthur

DOI- https://doi.org/10.13107/ijpo.2025.v11.i01.220

Open Access License: CC BY-NC 4.0

Submitted: 13/01/2025; Reviewed: 08/02/2025; Accepted: 15/03/2025; Published: 10/04/2025

Authors: Gaurav Gupta MS Ortho [1], Easwar T R MS Ortho [2], Hitesh Shah MS Ortho [3], Mohan V Belthur MS Ortho, FRCS (Tr & Orth), FRCSC [4, 5]

[1] Department of Orthopaedics, Child Ortho Clinic, Delhi-NCR, India.
[2] Department of Orthopaedics, Baby Memorial Hospital, Kozhikode, Kerala, India.
[3] Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India.
[4] Department of Orthopaedics, Phoenix Children’s Hospital, Phoenix, Arizona, USA.
[5] Department of Child Health & Orthopaedics, University of Arizona College of Medicine – Phoenix.

Address of Correspondence

Dr Mohan Belthur,
Department of Child Health & Orthopaedics, University of Arizona College of Medicine – Phoenix.
Director, Paediatric Limb Reconstruction Services
Co-Director, Neuroorthopaedic Services
Co-Director, Bubba Watson & Ping Motion Analysis Laboratory
Department of Orthopaedics, Phoenix Children’s Hospital, Phoenix, Arizona, USA.

Abstract

Skeletal dysplasias represent a heterogeneous group of over 500 genetic disorders affecting the growth, development, and structural integrity of bone and cartilage. Hip deformities in skeletal dysplasia (S.D) represent a significant challenge in pediatric orthopaedic practice. They significantly impact mobility and quality of life in children with S.D. Despite advances in surgical techniques and implant technology, patients with skeletal dysplasia continue to face higher complication rates and more challenging management decisions.
Early identification and intervention can prevent progressive deformity and secondary complications. A multidisciplinary approach combining careful preoperative planning, specialised surgical techniques, and dedicated rehabilitation protocols offers the best opportunity to optimise outcome.
Keywords: Skeletal Dysplasia, Hip deformities, Natural History, Management, Outcomes.

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How to Cite this Article: Gupta G, TR Easwar, Shah H, Belthur MV | The Hip in Skeletal Dysplasia: Evaluation & Management | International Journal of Paediatric Orthopaedics | January-April 2025; 11(1): 34-43.

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