J Knee Surg 2004; 17(2): 79-93
DOI: 10.1055/s-0030-1248203
Original Article

© 2004 Thieme Medical Publishers

Adolescent ACL Injury – Treatment Considerations

Raymond Pavlovich Jr , Steven H. Goldberg, Bernard R. Bach Jr 
  • The Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Ill
Further Information

Publication History

Publication Date:
27 January 2010 (online)

ABSTRACT

Anterior cruciate ligament (ACL) injury in a skeletally immature patient presents unique treatment challenges. In many cases, conservative treatment with bracing and physical therapy fails, resulting in recurrent instability, pain, swelling, and meniscal and chondral injury. The goal of surgical reconstruction is to recreate ACL stability without causing growth plate arrest, leg-length discrepancy, or angular deformity. Patient characteristics such as skeletal age, Tanner stage, onset of menses, family member height, growth spurt, recent change in foot size, and growth charts can help the surgeon approximate the degree of skeletal maturity and aid in selecting the timing and safest type of reconstruction. Numerous surgical techniques, ranging from an extra-articular reconstruction to intra-articular graft passage without physeal violation to standard transtibial and transfemoral tunnel placement with physeal violation, have been popularized. The majority of existing studies are retrospective case series, describing a particular author's specific technique experience. This article reviews the basic science and clinical literature, presents a treatment algorithm, and provides several case studies.

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