Management and complications of anterior cruciate ligament injuries in skeletally immature patients: survey of the Herodicus Society and The ACL Study Group.
Expert opinion regarding experience with the management and complications of pediatric anterior cruciate ligament (ACL) injuries was studied by surveying members of The Herodicus Society and The ACL Study Group. There was large practice variation in initial management and ACL reconstruction technique. There were 15 reported cases of growth disturbance: 8 cases of distal femoral valgus deformity with arrest of the lateral distal femoral physis, 3 cases of tibial recurvatum with arrest of the tibial tubercle apophysis, 2 cases of genu valgum without arrest, and 2 cases of leg length discrepancy. Associated factors included fixation hardware across the lateral distal femoral physis in 3 cases, bone plugs of a patellar tendon graft across the distal femoral physis in 3 cases, large (12 mm) tunnels in 2 cases, fixation hardware across the tibial tubercle apophysis in 3 cases, lateral extra-articular tenodesis in 2 cases, and over-the-top femoral position in 1 case. Based on this experience, we recommend a guarded approach to ACL reconstruction in the skeletally immature patient with careful attention to technique and follow-up.
Kocher
Mininder S
MS
Steadman-Hawkins Sports Medicine Foundation, Vail, Colorado, USA. mininder.kocher@tch.harvard.edu
Saxon
Hillary S
HS
Hovis
W David
WD
Hawkins
Richard J
RJ
D000367:Age Factors; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D001291:Attitude of Health Personnel; D001846:Bone Development / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology / Q000209:etiology; D006306:Health Surveys; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods; D009985:Orthopedics / Q000592:standards / Q000639:trends; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical; D011795:Surveys and Questionnaires