title: Management of the Anterior Cruciate Ligament-Injured Knee in the Skeletally Immature Athlete.
abstract: Intrasubstance tears of the anterior cruciate ligament (ACL) are being diagnosed with increasing frequency in the skeletally immature. Management options include nonoperative/ early surgical, or delayed surgical reconstruction. Nonoperative/delayed reconstruction results in worse functional outcomes than early reconstruction. Physicians are faced with a treatment dilemma; clinical and basic science studies have demonstrated risk of limb-length discrepancy and angular deformity with ACL reconstruction. Vertical drill tunnels decrease physeal damage and minimize growth deformity; however, this technique results in nonanatomic ACL graft placement. All-epiphyseal reconstruction avoids damage to the growth plate. These techniques are biomechanically superior to extraarticular and modified physeal-sparing procedures.
authors.affiliation: Tennessee Orthopaedic Alliance, 4230 Harding Road, Suite 1000, Nashville, TN 37205, USA.
authors.forename: Christian N
authors.initials: CN
authors.lastname: Anderson
authors.affiliation: Tennessee Orthopaedic Alliance, 4230 Harding Road, Suite 1000, Nashville, TN 37205, USA. Electronic address: andersonaf@toa.com.
authors.forename: Allen F
authors.initials: AF
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000070598:Anterior Cruciate Ligament Injuries / Q000175:diagnosis / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001182:Arthroscopy / Q000379:methods; D001265:Athletic Injuries / Q000175:diagnosis / Q000601:surgery*; D001846:Bone Development; D002648:Child; D006132:Growth Plate / Q000254:growth & development / Q000601:surgery; D006801:Humans; D008487:Medical History Taking; D010808:Physical Examination; D011859:Radiography; D013997:Time Factors
keywords: ACL; Knee; Pediatric; Physeal sparing; Reconstruction; Skeletally immature