RT Journal
A1 Anderson, Allen F.
T1 Transepiphyseal Replacement of the Anterior Cruciate Ligament in Skeletally Immature Patients: A Preliminary Report
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2011
FD February 16
VO 93
IS 4
SP e12 2
OP 3
DO 
UL http://dx.doi.org/
AB 
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. I have observed no growth disturbances, and the youngest patient was an eight-year-old boy. It seems logical to me that this procedure would be as safe in a five-year-old child as it is in an eight-year-old child, although I have no experience to support this assumption.