Document Title: Andrews-AJSM-Jan94.shtml
Article Title: Anterior Cruciate Ligament Allograft Reconstruction in the Skeletally Immature Athlete
Authors: Michelle Andrews, MD, Frank P. Noyes, MD, and Sue D. Barber-Westin
Publication: American Journal of Sports Medicine
Date: January 1994
Volume 22, Number 1, pages 48-54
Keywords: pediatric ACL, delayed reconstruction, skeletal immaturity, skeletally immature, knee, risk, meniscus, activity, activity restriction, pediatric ACL reconstruction, knee degeneration due to chronic ACL deficiency.

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Comments: This insightful study is one of the first to delve thoroughly into the topic of a modified intraarticular soft-tissue ACL reconstruction in the skeletally immature athlete. The authors describe in detail a method which, despite entailing some growth-plate penetration, did not bring any observed growth arrest. (The tibial tunnel is drilled through the centre of the growth plate, thereby avoiding the periphery of the plate and therefore avoiding concerns of angular growth deformities.) The authors do, however, recommend delaying intraarticular ACL reconstruction until skeletally maturity has been reached, or unless the patient has years of growth remaining, or if the patient has a very strong desire to continue athletics as soon as possible, or if the knee manifests giving-way during daily-living activities.

ABSTRACT

The purpose of this study was to evaluate anterior cruciate ligament allograft reconstruction in skeletally immature athletes. Eight patients (mean age, 13 years, 6 months; range, 10 to 15 years) with radiographic documentation of open growth plates had anterior cruciate ligament repair and reconstruction with fascia lata or Achilles tendon allograft tissue. A 7-mm graft was centrally placed across the tibial physes and in an over-the-top position on the femur. All patients returned for followup a mean of 58 months (range, 22 to 94) post-operatively. All had an immediate knee motion and rehabilitation exercise program. The results were rated on a comprehensive rating system that assessed 20 variables. At followup, all patients showed closure of the growth plates. The difference in lower limb length, measured on scanograms, was not clinically significant. On KT-1000 arthrometer testing, 5 patients had less than 3 mm of increased anterior-posterior displacement (normal knee minus reconstructed knee) and 3 patients had between 3 and 5 mm. The final overall ratings were 6 excellent, 1 good, and 1 fair. The procedure is infrequently used, but appears to have merit in select, skeletally immature athletes who desire not to modify athletic activity or when associated meniscal repairs warrant consideration for reconstruction.

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