Anterior Cruciate Ligament Injuries in Patients with Open Physes

Abstract

From July 1988 to August 1989, six children with open physes and injuries to the anterior cruciate ligament were treated operatively. All injuries involved twisting episodes during sports activities. All six patients had meniscal abnormalities, and, additionally, one patient sustained a Grade III medical ligament tear and had a lateral patellar dislocation. Operative reconstruction used hamstring tendons and place a groove over the front of the tibia and a groove over the top of the femur without violation of the growth plates. The anterior cruciate ligament was primarily repaired (three patients) at the time of reconstruction, if possible. At 3 months, one patient underwent arthroscopic resection of adhesions for arthrofibrosis. There were no other complications. Five patients were evaluated with clinical examination, radiographs, magnetic resonance imaging, and functional testing at an average followup of 33.2 months (range, 25 to 38). Four of the five had returned to their preinjury level of sports participation. Manual maximum KT-1000 arthrometer side-to-side differences averaged 3.6 +/- 1.9 mm. The average Lysholm knee score was 95.2 +/- 2.5; the average Hospital for Special Surgery knee score was 96.6 +/- 2.3. There were no growth plate injuries. Despite the overall clinical stability, magnetic resonance image scans of the five patients consistently demonstrated areas of increased signal in the anterior cruciate ligament grafts.

Pediatric anterior cruciate ligament reconstruction

“…Six of 9 patients were satisfied at 3 years and returned to their previous level of sport participation. Parker et al [41] performed a similar procedure but made a trough in the tibial epiphysis to allow a more isometric reconstruction. Four of 5 patients returned to their previous level of competition and there were no growth disturbances noted in either study.…”

Management of anterior cruciate ligament injuries in skeletally immature adolescents

“…For this reason, an extraarticular ACL reconstruction is not recommended for an young athlete with an ACL-deficient knee. ACL reconstruction using different graft sources such as autogenous central 10-mm patellar tendon [ 18], hamstring tendons [22], or allograft tissue (fascia lata or Achilles tendon) [ 1 ] have been reported in the literature. Intraarticular ACL reconstruction that avoids penetration of growth plates has also been reported [5,8].…”

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

“…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]. The risk of damaging open physes is connected to the growth age and the choice of the procedure [7][8][9].…”

“…This seems to be a good option [16][17][18][19][20], but some investigators report that the implant is not isometric [21] and anatomic [22]. Although these physeal-sparing techniques have provided relatively good short-term results, the lack of long-term outcomes casts some doubt on the durability and nature of these procedures.…”