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.
Keywords: ACL; Knee; Pediatric; Physeal sparing; Reconstruction; Skeletally immature.
Copyright © 2016 Elsevier Inc. All rights reserved.