Anterior Cruciate Ligament Injuries in Skeletally Immature Patients: An Updated Review of Research and Treatment Options

Abstract

Reconstruction of the ACL in skeletally immature patients is a topic of constant debate and research because of the risk of significant physeal injury about the knee resulting from femoral and tibial tunnel drilling and placement of therapeutic hardware. Surgical techniques for reconstructing the ACL may violate the proximal tibial, distal femoral, and tibial tubercle physes and can potentially cause premature growth arrest with resultant limb-length discrepancy or angular deformity of the lower extremity. This article is a review of the literature on reconstruction of the ACL in children and adolescents, including recently reported studies of surgical reconstruction in adolescent patients and animals, with a specific focus on physeal injury and surgical technique. These studies indicate that reconstruction of the ACL in patients with open physes is a viable option, although the small possibility of its inducing physeal injury remains a significant concern. Special consideration should be given to technique, anatomy, and hardware placement in such repair for each individual patient, and may reduce the risk of disturbances in physeal growth from reconstruction of the ACL.

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