Document Title: Micheli-CORR-Jul99.shtml
Article Title: Anterior Cruciate Ligament Reconstruction in Patients Who Are Prepubescent
Authors: Micheli, Lyle J. MD, Rask, Bart MD; Gerberg, Lynda MD
Publication: Clinical Orthopedics and Related Research
Date: July 1999
Volume 364, pages 40-47
Keywords: pediatric ACL reconstruction, epiphyses, growth plates, soft-tissue reconstruction, skeletal immaturity.

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Comments: Micheli et al. describe how they obtained good results by using the iliotibial band to reconstruct the ACL in pediatric patients. This extra-articular method retains the attachment of the iliotibial band at one end, and loops it around through obliquely-drilled holes. This method avoids compromising the growth plates and therefore circumvents potential concerns of growth arrest and angular deformity. But additionally, because this method does not entail harvesting any graft material from the hamstring area, it also avoids compromising the hamstring group. (This is a major advantage, given the biomechanical importance of the hamstring group, both in terms of knee functioning and in terms of ACL-injury/reinjury prevention.) Although Micheli recommends that this method be presented as being temporary in nature (given that this method makes the knee anatomically and physiologically rather abnormal, especially when compared to the standard intra-articular tendon-grafting procedures used in adults), he notes that the patients in the study (at time of publication) had not yet required revision reconstruction.

Abstract

Between 1980 and 1996, 17 children who were prepubescent have had a combined intraarticular and extraarticular reconstruction of the anterior cruciate ligament using the iliotibial band that does not violate the physes. The average chronological age of the patients was 11 years (range, 2-14 years) and the average skeletal age of the patients was 10 years (range, 2-13 years). Eight of the 10 patients who had attained skeletal maturity were evaluated at an average of 66.5 months postoperatively (range, 25-168 months). All knees were stable subjectively by history and objectively by KT1000™ testing. The average Lysholm score at assessment was 97.4. No child with a traumatic disruption had leg length discrepancy develop.

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