A.F. Anderson replies:
I appreciate Dr. Parikh’s thoughtful questions regarding transepiphyseal ACL reconstruction.
Dr. Parikh’s first question concerns the safety of this technique for children at Tanner stage I of sexual maturity. Unfortunately, the orthopaedic literature is deficient both with regard to age-specific basic science on the effects of physeal injury and with regard to clinical studies demonstrating the safety of the various surgical techniques that can be used to reconstruct the ACL in pediatric patients. Although the methods of treatment remain controversial, it is widely accepted that the consequences of iatrogenic growth disturbance, should they occur following ACL reconstruction, are greater for younger children. Consequently, my bias in the presence of this uncertainty is to treat high-risk, prepubescent patients in Tanner stages I or II and intermediate-risk patients in early Tanner stage III with this “physeal sparing” procedure. I have performed fifty transepiphyseal ACL reconstructions, thirty-one of which were in patients who were in Tanner stages I or II. …
Enter your JBJS login information below.
Please note that your username is the email address you provided when you registered.