An anterior cruciate ligament (ACL) tear is a major knee injury that is being seen with increasing frequency among children and teenagers. The injury can be painful and limiting to your activities, especially for athletes. Doctors have long debated the best way to treat these injuries and have developed both non-operative and operative treatment strategies. To help us understand what the best treatments are, we created the PLUTO Study (Pediatric ACL: Understanding Treatment Outcomes), which is an ongoing cohort study that follows children with ACL tears at 10 different hospitals across the United States.
PLUTO strives to evaluate the safety and effectiveness of each treatment strategy for the pediatric age group, and it is the first study of its size to do so. The study looks at four different operative treatment options used for prepubescent and pubescent patients with ‘open’, or still functioning, growth plates -- (1) transphyseal ACL reconstruction, (2) partial transphyseal ACL reconstruction, (3) physeal-sparing all-epiphyseal ACL reconstruction, and (4) physeal-sparing ACL extra-epiphyseal reconstruction -- and non-operative treatment.
This study is vital because it will provide stronger data to help orthopedic surgeons better understand and recommend the appropriate treatment for their young patients with ACL tears, helping them return to healthy activity while minimizing risks of re-injury and other complications, like arthritis.
An important feature about the PLUTO study is that it is considered ‘observational research’, meaning that participating patients are not undergoing experimental treatments. Rather, the treatments they are receiving are all well-established and are the same that the patient would receive if they were not a participant in the study. Study participation simply means that they will be enrolled in a privacy-protected electronic database of patients undergoing similar treatments and the results of the treatments—how patients feel, when they return to sports, how their knee functions—will be analyzed collectively and compared against other established treatments.
PLUTO continues to recruit participants seeking care for torn ACLs at its participating centers and hospitals. Active participating sites include:
- Boston Children’s Hospital
- Children’s Hospital of Philadelphia
- Children’s Hospital of Atlanta
- Tennessee Orthopedic Alliance
- Cincinnati Children’s Hospital Medical Center
- Rady Children’s Hospital of San Diego
- Washington University of St. Louis
- Cleveland Clinic
- Hospital for Special Surgery
- Stanford University Medical Center
After PLUTO patients receive treatment, our orthopedic surgeons and research coordinators continue to follow up with them for up to 10 years, both in clinic and through annual surveys. This gives us a unique perspective of how our patients perform, both in everyday activities and as athletes, not only during their care, but also long after. We hope to gain an unparalled picture of the long-term outcomes for young patients who are treated for ACL tears and inspire the best treatment courses for them, based on their unique needs for years to come.