Anterior Cruciate Ligament Injury in Paediatric and Adolescent Patients
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INJURY CLINIC
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Anterior Cruciate Ligament Injury in Paediatric and Adolescent Patients A Review of Basic Science and Clinical Research Kevin G. Shea,1 Peter J. Apel1 and Ronald P. Pfeiffer2 1 2
Intermountain Orthopaedics, Boise, Idaho, USA Department of Kinesiology, Boise State University, Boise, Idaho, USA
Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455 1. Risk Factors and Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 456 2. Natural History of Non-Reconstructive Management of Anterior Cruciate Ligament (ACL) Injuries 456 3. Animal Studies, Mechanisms of Physeal Arrest and Growth Abnormalities . . . . . . . . . . . . . . . . . . . . . . 458 3.1 Bony Bar Formation and Hardware Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 458 3.2 Tenodesis Effect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461 4. Anatomy of the Proximal Tibia and Distal Femoral Physes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462 5. Reported Complications After ACL Reconstruction in Skeletally Immature Patients . . . . . . . . . . . . . . 463 6. Methods of ACL Reconstruction in Skeletally Immature Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464 6.1 Physeal Sparing Techniques: Both Tibial and Femoral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464 6.2 Physeal Sparing Techniques: Femoral Side Only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467 6.3 Non-Physeal Sparing Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 468 7. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469
Abstract
Anterior cruciate ligament (ACL) injuries are recognised with greater frequency in children and adolescents. Non-operative treatment of ACL injuries in children may lead to knee instability and secondary injuries, especially in those who return to sports. ACL reconstruction is controversial in skeletally immature patients because of potential damage to the proximal tibial and distal femoral physes, which may lead to premature arrest and/or leg length discrepancies. This paper reviews studies of ACL injuries in children and adolescents, and examines basic science and clinical studies concerning physeal arrest secondary to ACL reconstruction tunnels. Some animal studies support the conclusion that ACL reconstructions in children have the potential to cause growth disturbances, and there are reports of growth plate complications due to ACL reconstru
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