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Minerva Ortopedica e Traumatologica 2004 October;55(5):169-84


language: English

Anterior cruciate ligament in skeletally immature patients

Shea K. G. 1, Apel P. 1, Pfeiffer R. P. 2, Hutt N. 1

1 Intermountain Orthopaedics, Boise, ID, USA 2 Department of Kinesiology Boise State University, Boise, ID, USA


Anterior crucuate ligament (ACL) injuries in children and adolescents are increasing. Conservative or delayed treatment of ACL injuries in active children or athletes is frequently impractical, as young athletes may not comply with activity limitations. Non-surgical treatment often leads to knee instability and secondary meniscal tears in athletes that continue high demand sports. These secondary injuries my lead to the development of early osteoarthritis. Transphyseal ACL reconstruction in skeletally immature patients is controversial because of potential damage to the physes, which may lead to premature physeal arrest and/or lower extemity length discrepancies. Physeal sparing techniques have been criticized as being non-isometric and non-anatomic. In addition, the long-term function of these grafts into adulthood is unknown. In this review, the natural history of conservatively treated ACL injuries, and the basic science of physeal arrest are discussed. Some animal studies support the conclusion that ACL reconstructions in children have the potential to cause growth disturbances, however, there are few reports of actual complications due to ACL reconstruction in skeletally immature patients. A variety of operative techniques and clinical studies of ACL reconstruction in skeletally immature patients have been published and their results are summarized and discussed. Evidence suggests that factors that influence the likelihood of physeal arrest are tunnel size, placement, presence of hardware that crosses the physis, and tension of the graft. Although the potential for a physeal complication exists, there is evidence that transphyseal ACL reconstruction can be safely performed in select skeletally immature patients if anatomy, surgical technique and hardware placement are carefully considered. These patients and the families should be aware of the potential for physeal complications, and non-operative treatment until the patients are skeletally mature remains a treatment option.

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