title: Surgical-experimental principles of anterior cruciate ligament (ACL) reconstruction with open growth plates.
abstract: OBJECTIVE
  To review surgical and animal experimental studies performed with open growth plates in relation with pediatric anterior cruciate ligament (ACL) reconstruction.
  
  
  BACKGROUND
  When it comes to the treatment of ACL injured children, there is a lack of current international guidelines, leaving the treating physicians with a therapeutic dilemma. A variety of surgical and animal experimental studies have been undertaken over the last decades in relation with open growth plates and ACL-reconstruction.
  
  
  METHODS
  Based on our own previous animal experimental data, we highlighted 15 specific points concerning pediatric ACL-reconstruction and reviewed additional literature concerning these individual items.
  
  
  RESULTS
  Pediatric ACL-reconstruction could be proven to be safe in animal models. Growth abnormalities, risk factors and factors, which were specifically related to biological healing processes in children, were identified. From them surgical principles for safe pediatric ACL replacements can be deducted. Applying these principles through a correct technical execution of surgery may prevent clinically significant growth changes.
  
  
  CONCLUSIONS
  Over the last 2 decades it has been shown that a technically correct pediatric ACL reconstruction has little risk in creating clinically significant growth abnormalities. Animal experiments support this hypothesis despite the fact that the gained knowledge cannot be fully generalized to humans. More long time follow-up is needed to fully understand the complete risk factors related to ACL surgery with open growth plates.
authors.affiliation: Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg, Clinique d'Eich. 78, rue d'Eich, L-1460, Luxembourg, Luxembourg. rseil@yahoo.com.|Sports Medicine Research Laboratory, Luxembourg Institute of Health, 78 rue d'Eich, L-1460, Luxembourg, Luxembourg. rseil@yahoo.com.
authors.forename: Romain
authors.initials: R
authors.lastname: Seil
authors.affiliation: Department of Pediatric Surgery, University of Tampere, Teiskontie 35, 33521, Tampere, Finland. frederick.weitz@fimnet.fi.
authors.forename: Frederick K
authors.initials: FK
authors.lastname: Weitz
authors.affiliation: Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg, Clinique d'Eich. 78, rue d'Eich, L-1460, Luxembourg, Luxembourg. dietrichpape@yahoo.de.|Sports Medicine Research Laboratory, Luxembourg Institute of Health, 78 rue d'Eich, L-1460, Luxembourg, Luxembourg. dietrichpape@yahoo.de.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Pape