Document Title: Koman-JBJS-May99.shtml
Article Title: Valgus Deformity After Reconstruction of the Anterior Cruciate Ligament in a Skeletally Immature Patient. A Case Report
Authors: Jon D. Koman MD and James O. Sanders MD
Publication: The Journal of Bone and Joint Surgery (American Edition)
Date: February 2000
Volume 82, pages 711-715
Keywords: Pediatric ACL reconstruction, open growth plates (epiphyses), skeletal immaturity.

(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)

Comments: This study shows what can happen if a pediatric ACL reconstruction is performed incorrectly. Although in this case a soft-tissue graft was used (and so there was no concern of graft bone plugs bridging the growth plates [physes], as would have been the concern if a patellar-tendon autograft had been chosen), the graft-anchorage device (a cannulated transverse transfixing screw) was installed so that it crossed the femoral growth plate on the lateral side. The result was that the growth plate closed prematurely on the lateral side, thereby resulting in the young patient being left with knockkneedness. A tibial osteotomy, to correct the valgus angulation, was needed. (This article includes follow-up in the form of a letter to the editor by O.O. Oni; also present is the author's response.)

Introduction

Whether acute or chronic, rupture of the anterior cruciate ligament is uncommon in children, most likely because the strength of the ligament is greater than that of bone or physes in children3,5. However, intrasubstance ruptures of the anterior cruciate ligament can occur in young patients1,2,4,6-8,11-17,19. A heightened awareness of injuries to the ligament and the fear of irreparable damage to the cartilage and menisci have created a trend toward operative treatment1,2,4,6-8,11-17,19. Intra-articular reconstruction of the anterior cruciate ligament has been successful in adults; however, drilling across an open growth plate is a cause of concern because it may lead to the formation of an osseous bridge, resulting in premature physeal closure, limb-length discrepancy, and angulation of the involved extremity10.

We report on a fourteen-year-old boy who was managed with a transphyseal intra-articular reconstruction of the anterior cruciate ligament of the right knee. He subsequently had premature closure of the distal femoral physis that resulted in a valgus deformity of the lower extremity.

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