The management of anterior cruciate ligament injuries in skeletally
immature patients is controversial. Conventional adult reconstruction
techniques risk potential iatrogenic growth disturbance due to physeal damage.
The purpose of this study was to evaluate the results of a physeal sparing,
combined intra-articular and extra-articular reconstruction technique in
prepubescent skeletally immature children.
Between 1980 and 2002, forty-four skeletally immature prepubescent children
and adolescents who were in Tanner stage 1 or 2 (with a mean chronological age
of 10.3 years) underwent physeal sparing, combined intra-articular and
extra-articular reconstruction of the anterior cruciate ligament with use of
an autogenous iliotibial band graft. Twenty-seven patients had additional
meniscal surgery. Functional outcome, graft survival, radiographic outcome,
and growth disturbance were evaluated at a mean of 5.3 years after
Two patients underwent a revision reconstruction for graft failure at 4.7
and 8.3 years postoperatively. In the remaining forty-two patients, the mean
International Knee Documentation subjective knee score (and standard
deviation) was 96.7 ± 6.0 points, and the mean Lysholm knee score was
95.7 ± 6.7 points. The results of the Lachman examination for anterior
cruciate ligament integrity were normal for twenty-three patients, nearly
normal for eighteen patients, and abnormal for one patient. The results of the
pivot-shift examination were normal for thirty-one patients and nearly normal
for eleven patients. Four of the twenty-three patients who underwent
concurrent meniscal repair had a repeat arthroscopic meniscal repair or
partial meniscectomy. The mean growth in total height from the time of surgery
to the final follow-up evaluation was 21.5 cm. No patient had an angular
deformity measured radiographically or a discrepancy in the length of the
lower extremities measured clinically.
Physeal sparing, combined intra-articular and extra-articular
reconstruction of the anterior cruciate ligament with use of an autogenous
iliotibial band graft in skeletally immature prepubescent children and
adolescents provides excellent functional outcome with a low revision rate and
a minimal risk of growth disturbance.