ACL lesions surgical treatment in pediatric patients. Our all-epiphyseal experience
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The prevalence of traumatic knee disease in children and young athletes has steadily increased over the past few years. The subjects who have engaged in intense sporting activities since a young age were especially vulnerable to developing an anterior cruciate injury. With the development of new imaging and clinical examination methods, diagnosis has also improved. The need to ensure joint growth without complications and the rising demands for a return to competitive sport are driving the search for an appropriate surgical technique. Today, only a few cases should receive conservative treatment. The main flaw of the extra-articular technique is that it doesn't respect the anatomy and results in excessive rigidity. Even precocious subjects can use the allepyphiseal technique, which allows for the respect of the growth plates. It does not present a particularly high complication rate and permits a full return to sports activities prior to the trauma with an adequate learning curve on the part of the surgeon. However, in more mature subjects with still open physis, the traditional transepiphyseal arthroscopic technique is possible as long as the tunnel is not too large. In any case, it is crucial to provide a thorough and ongoing follow-up until the end of growth as well as individualized rehabilitation.
Dodwell ER, Lamont LE, Green DW, Pan TJ, Marx RG, Lyman S. 20 years of pediatrics anterior cruciate ligament reconstruction in New York State. Am J Sports Med 2014;40:2128-33. DOI: https://doi.org/10.1177/0363546513518412
Shea KG, Pfeiffer R, Wang JH, et al. Anterior cruciate ligament injury in pediatric and adolescent soccer players: an analysis of insurance data. J Pediatr Orthop 2004;24:623-8. DOI: https://doi.org/10.1097/01241398-200411000-00005
Henry J, Chotel F, Chouteau J, et al. Rupture of the anterior cruciate ligament in children: Early reconstruction with open Physes or delayed reconstruction to skeletal maturity? Knee Surg Sports Traumatol Arthorosc 2009;17:748-55. DOI: https://doi.org/10.1007/s00167-009-0741-0
Memeo A, Pedretti L, Miola F, Albisetti W. Anterior cruciate ligament recostruction with bone-patellar tendon-bone autograt in Tanner 3 stage patients with open Physes. J Ped Orthop B 2012;21:415-20. DOI: https://doi.org/10.1097/BPB.0b013e328348aa47
Lawrence JT, Bowers AL, Belding J, et al. All –epiphyseal anterior cruciate ligament reconstruction in skeletally immature patients. Clin Orthop Relat Res 2010;468:1971-7. DOI: https://doi.org/10.1007/s11999-010-1255-2
Anderson AF. Transepiphyseal replacement of the anterior cruciate ligament in skeletally immature patients. A preliminary report. J Bone Joint Surg Am 2003;85:1255-63. DOI: https://doi.org/10.2106/00004623-200307000-00011
Kennedy A, Coughlin DG, Metzger MF. Biomechanical evaluation of pediatric anterior cruciate ligament reconstruction techniques. Am J Sports Med 2011;39:964-71 DOI: https://doi.org/10.1177/0363546510390189
Kocher MS, Smith JT, Zoric Bj, et al. Transepiphyseal anterior cruciate ligament in skeletally immature pubescent adolescents. J Bone Joint Surg Am 2007;89:2632-9. DOI: https://doi.org/10.2106/JBJS.F.01560
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