Valgus Deformity After Reconstruction of the Anterior Cruciate Ligament in a Skeletally Immature Patient. A Case Report*

Koman, Jon D.; Sanders, James O.

doi:10.2106/00004623-199905000-00014

Cited by 199 publications

(117 citation statements)

References 17 publications

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“…Komann et al reported on a 14-year-old boy who received a transphyseal intra-articular reconstruction of the ACL and had premature closure of the distal femur physis that resulted in a valgus deformity of the lower extremity [14]. They suggest a delayed reconstruction of a ruptured anterior cruciate ligament until the patient reaches skeletal maturity.…”

Section: Discussionmentioning

confidence: 99%

“…Reports on primary repair and extraarticular reconstruction procedures have shown only little success at providing long-term knee stability [6,17,18]. On the other hand, intraarticular anatomical reconstruction of the ACL may lead to physeal injury and lower extremity deformities [14]. Others suggest that surgical correction with the use of techniques similar to those used in adult reconstruction produces satisfactory mechanical results without physeal damage, varus or valgus angulation or leg-length discrepancy [8,12].…”

Section: Introductionmentioning

confidence: 99%

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The functional outcome of total tears of the anterior cruciate ligament (ACL) in the skeletally immature patient

Arbes

Resinger

Vécsei

et al. 2006

International Orthopaedics (SICO

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Tears of the anterior cruciate ligament (ACL) in the skeletally immature patient are becoming more prevalent. The aim of this study was to describe the functional outcome and to evaluate the best management of total tears of the ACL in skeletally immature patient. Twenty consecutive, skeletally immature patients with a clinically evident rupture of the anterior cruciate ligament were followed up for a mean of 5.4 years. The mean age at the time of injury was 13.9 years old. The study group consisted of 13 girls and 7 boys, who were treated either conservatively, by ACL reconstruction, by primary repair or by delayed ACL reconstruction after skeletal maturity had been reached. Clinical outcomes were measured using the International Knee Documentation Committee Scoring System (IKDC) and the Knee Injury and Osteoarthritis Outcome Scoring System (KOOS). The radiological evaluation was performed using Jaeger and Wirth's criteria, and instrumented laxity testing was carried out with a Rolimeter. Five of the eight patients treated conservatively showed poor function of the knee, and this resulted in instability. Concerning the patients treated by primary repair, delayed ACL reconstruction or arthroscopic debridement, we also found none of the results to be satisfactory (seven of eight patients). The patients that were treated by a reconstruction had the best results. This was confirmed by clinical examination (Lachmann grade 1), by the IKDC (grade B) and by the KOOS with the best quality of life and no giving-way attacks. The level of evidence was therapeutic level III. Résumé Les ruptures du ligament croisé antérieur chez des jeunes patients qui ne sont pas encore à maturité osseuse deviennent de plus en plus nombreuses. Le but de cette étude est de décrire l'avenir fonctionnel et d'évaluer le meilleur traitement de ces ruptures du croisé antérieur chez des sujets au squelette immature. Vingt patients consécutifs en cours de croissance ayant présenté de façon évidente sur le plan clinique une rupture du ligament croisé antérieur ont été suivis sur une moyenne de 5,4 ans. L'âge moyen au moment du traumatisme était de 13,9 ans. Le groupe étudié consiste en 13 filles et 7 garçons qui ont tous été traités par reconstruction du ligament croisé antérieur de façon immé-diate ou, par reconstruction secondaire après fermeture du cartilage de croissance. L'avenir clinique des patients a été étudié selon le score de l'IKDC et du KOOS. L'étude radiologique a utilisée les critères de Jaeger et de Wirth et la laxité a été mesurée avec un Rolimeter. Les patients ont été traités soit par réparation immédiate du ligament croisé antérieur soit par réparation secondaire. Cinq patients (62.5%) traités de façon orthopédique ont montré un résultat clinique médiocre avec une instabilité résiduelle. Les patients traités par réparation primaire ou secondaire du ligament croisé antérieur avec reconstruction ou nettoyage sous arthroscopie non, également pas eu de résultats satisfaisants pour sept d'entre-eux (87.5%). Les patients qui o...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The functional outcome of total tears of the anterior cruciate ligament (ACL) in the skeletally immature patient

Arbes

Resinger

Vécsei

et al. 2006

International Orthopaedics (SICO

View full text Add to dashboard Cite

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“…Reports of complications of ACL reconstruction in skeletally immature patients are rare and most of the documented growth complications are attributable to surgeon error such as placement of a fixation device across a growth plate [5,[60][61][62]. Kocher et al [60] surveyed the Herodicus Society and ACL study group and reported 15 cases of growth disturbance.…”

Section: Transphyseal Techniquesmentioning

confidence: 99%

Pediatric anterior cruciate ligament reconstruction

McConkey

Bonasia

Amendola³

2011

Curr Rev Musculoskelet Med

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An increasing number of anterior cruciate ligament (ACL) injuries are seen in children now than in the past due to increased sports participation. The natural history of ACL deficient knees in active individuals, particularly in children is poor. Surgical management of ACL deficiency in children is complex due to the potential risk of injury to the physis and growth disturbance. Delaying ACL reconstruction until maturity is possible but risks instability episodes and intra-articular damage. Surgical options include physeal-sparing, partial transphyseal and complete transphyseal procedures. This article reviews the management of ACL injured skeletally immature patients including the functional outcome and complications of contemporary surgical techniques.

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“…Making an accurate diagnosis can be difficult as there is a spectrum of injuries including tibial avulsions, partial ACL tears, and complete tears, and there can be multiple barriers to performing an accurate examination in this patient population. Also, there is some controversy over the appropriate treatment of these injuries in the pediatric and adolescent patient, mostly out of concern for the physis and potential growth disturbances [4,[7][8][9]. If surgery is chosen, there is debate over the appropriate technique as well as graft choice.…”

Section: Introductionmentioning

confidence: 99%

Pediatric ACL injuries: evaluation and management

Mall¹,

Paletta

2013

Curr Rev Musculoskelet Med

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The anterior cruciate ligament (ACL) is a stabilizing structure to both anterior translation of the tibia with respect to the femur as well as rotation of the knee joint. Children and adolescents are susceptible to these injuries, and there are some who believe the incidence of ACL injuries in this population is increasing due to year round single sport participation. Pediatric ACL injuries are typically seen in several forms: tibial avulsion fractures, partial ACL tears, and full thickness ligament tears. There were and still are some who feel that ACL injuries should be treated non-operatively in the pediatric and adolescent population; however, recent literature refutes this notion. Several factors must be considered during pediatric and adolescent ACL reconstruction, each of which will be examined in this manuscript, including: status of the physis, reconstruction technique, and graft source.

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Valgus Deformity After Reconstruction of the Anterior Cruciate Ligament in a Skeletally Immature Patient. A Case Report*

Cited by 199 publications

References 17 publications

The functional outcome of total tears of the anterior cruciate ligament (ACL) in the skeletally immature patient

The functional outcome of total tears of the anterior cruciate ligament (ACL) in the skeletally immature patient

Pediatric anterior cruciate ligament reconstruction

Pediatric ACL injuries: evaluation and management

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