Management of complete traumatic anterior cruciate ligament tears in the skeletally immature patient: Current concepts and review of the literature

Delayed Anterior Cruciate Ligament Reconstruction in Adolescents with Open Physes

“…In addition, the rate of meniscus injury in the physes group (46%) was similar to the rate of meniscus injury previously reported for adolescents with traumatic ACL rupture ("at least 50%") in a literature review by Nottage and Matsuura. 28 The only group with a notably higher rate of additional knee injuries (69%) was group 4 (chronic ACL insufficiency). In comparison to the physes group, the adolescents in group 4 were less likely to have restricted their activities during their unintentional delay from injury to surgery.…”

“…First, nonanatomic graft position produces substantial changes in graft tension with knee flexion. 4,12,28,32 Second, these procedures may use potentially weaker graft fixation methods, depending on the graft source and fixation technique. 15 Third, the long-term (that is, into adulthood) integrity of the nonanatomic grafts are unknown.…”

Transphyseal Reconstruction of the Anterior Cruciate Ligament Using Hamstring Autograft in Skeletally Immature Adolescents

“…However, a poor prognosis was reported for primary repair in both adults and children (5, 10, 18). The merit of extraarticular reconstruction lies in the fact that no transphyseal tunnel is created, and thus this procedure poses little risk of growth disturbance, but it suffers from the drawback that the reconstructed ACL is nonisometric, even after a long follow-up, and thus the prognosis could not be concluded (3, 16, 19, 20).…”

Growth Arrest of the Tibia After Anterior Cruciate Ligament Reconstruction

“…§ Nonoperative treatment of such injuries is seldom effective, often leading to further knee joint complications. 6,[13][14][15]20 Consequently, surgical intervention in which the ACL is reconstructed remains the best treatment option for patients with recurrent instability. Anatomical reconstruction of the ligament is optimal; however, skeletal immaturity of children and adolescents makes this technique run the risk of physeal growth plate damage.…”