Technical Information about ACL Injuries in Children.

Last updated Thursday, January 13, 2005

Conclusion

What are the main points to know about anterior cruciate ligament (ACL) in children?

• Bony avulsions of the anterior cruciate ligament can be anatomically restored.
• Partial tears of the ACL in this age group should normally be treated without surgery unless significant patholaxity is present.
• Postpubertal patients who are nearing skeletal maturity should be treated as adults.
• Centrally placed transphyseal drill holes of the smallest possible diameter are preferred by the authors.
• Excessive dissection near a physis or placement of fixation devices near a physis should be avoided.
• Soft tissue grafts only should be utilized in prepubescent patients. Bone blocks or fixation devices across the physis should be avoided.
• A careful plan must be in place to monitor subsequent bone growth, and a plan for intervention should be in place if premature physeal closure occurs.

The effect of surgical intervention on subsequent growth in the skeletally immature patient is a major factor influencing treatment decisions. The risks of surgery must be weighed against the potential damage to the knee caused by repeated participation and instability, which are common in this age group. It is essential to prevent repeat injuries and if this can not be done in a non operative manner then surgical intervention should be considered.

References

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28. Andrews M, Noyes FR, Barber-Westin SD: Anterior cruciate ligament allograft reconstruction in the skeletally immature athlete. Am J Sports Med 1994, 22(1):48-54.

29. Matava MJ, Siegel MG: Arthroscoic reconstruction of the ACL with semitendinosus-gracilis autograft in skeletally immature adolescent patients. Am J Knee Surg 1997, 10:60-69.

30. Tanner JM, Whitehouse RM, Marshall WA et al: Assessment of Skeletal Maturity and Prediction of Adult Height (TW2 method), London, Academic Press, 1075.

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Disclaimer

This resource has been provided by the University of Washington Department of Orthopaedics and Sports Medicine as general information only. This information may not apply to a specific patient. Additional information may be found at http://www.orthop.washington.edu or by contacting the UW Department of Orthopaedics and Sports Medicine.

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