Anterior Cruciate Ligament Allograft Reconstruction in the Skeletally Immature Athlete

Abstract

The purpose of this study was to evaluate anterior cruciate ligament allograft reconstruction in skeletally immature athletes. Eight patients (mean age, 13 years, 6 months; range, 10 to 15 years) with radiographic documentation of open growth plates had anterior cruciate ligament repair and reconstruction with fascia lata or Achilles tendon allograft tissue. A 7-mm graft was centrally placed across the tibial physes and in an over-the-top position on the femur. All patients returned for followup a mean of 58 months (range, 22 to 94) postoperatively. All had an immediate knee motion and rehabilitation exercise program. The results were rated on a comprehensive rating system that assessed 20 variables. At followup, all patients showed closure of the growth plates. The difference in lower limb length, measured on scanograms, was not clinically significant. On KT-1000 arthrometer testing, 5 patients had less than 3 mm of increased anterior-posterior displacement (normal knee minus reconstructed knee) and 3 patients had between 3 and 5 mm. The final overall ratings were 6 excellent, 1 good, and 1 fair. The procedure is infrequently used, but appears to have merit in select, skeletally immature athletes who desire not to modify athletic activity or when associated meniscal repairs warrant consideration for reconstruction.

Pediatric anterior cruciate ligament reconstruction

“…The graft is typically placed through a transphyseal tibial tunnel and then is fixed to the femur in an over-the-top position [46][47][48], or in epiphyseal tunnels [9,49].…”

“…There was one leg length discrepancy due to accidental physeal stapling during graft fixation. Andrews et al [46] reported a series of 8 patients treated with transphyseal tibial tunnels and over-the-top femoral placement. They reported 6 excellent, 1 good and 1 fair result at an average of 58 months follow-up with no significant leg length discrepancies.…”

Análise comparativa das propriedades mecânicas do ligamento da patela e do tendão calcâneo

“…A análise da literatura em biomecânica a respeito dos substitutos citados permite notar que tem sido pouco estudado o perfil mecânico do tendão calcâneo, embora sua aplicação clinica venha sendo recomendada por diversos autores (1,5,12,17,18) .…”

Anterior cruciate ligament recostruction with bone-patellar tendon-bone autograft in Tanner 3 stage patients with open physes

“…If we focus our attention on adolescents with growth remaining (boys: 13-16 years; girls: 12-14 years), primary repair and extraarticular procedures are not recommended [10,11]. Intraarticular, however, extraphyseal techniques might be used in the treatment of ACL lesion in children and adolescents with wide-open physes and this seems to be a good option [16,17,19,26,29]. However, some investigators still report that the implant is not isometric [21] and anatomic [22], whereas others demonstrate a low rate of growth damage [19,20].…”