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J Am Acad Orthop Surg, Vol 14, No 13, December 2006, 736-744.
© 2006 the American Academy of Orthopaedic Surgeons
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Surgical Management of Anterior Cruciate Ligament Injuries in Patients With Open Physes

Mitchell W. Larsen, MD, William E. Garrett, Jr, MD, PhD, Jesse C. DeLee, MD and Claude T. Moorman, III, MD

Dr. Larsen is Orthopaedic Surgeon, Central Utah Sports Medicine, Department of Orthopaedics, Central Utah Clinic, Provo, UT. Dr. Garrett is Professor, Department of Orthopaedics, Duke University Medical Center, Durham, NC. Dr. DeLee is Clinical Professor, Department of Orthopaedics, University of Texas Health Science Center at San Antonio, San Antonio, TX. Dr. Moorman is Chief, Division of Sports Medicine, Department of Orthopaedics, Duke University Medical Center.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Larsen, Dr. Garrett, Dr. DeLee, and Dr. Moorman.

Reprint requests: Dr. Larsen, Department of Orthopaedics, Central Utah Clinic, Suite 121, 1055 N 500 W Building C, Provo UT 84604.

Because of the increasing number of skeletally immature athletes who compete in highly demanding sports, more children than previously are sustaining anterior cruciate ligament injuries. Treatment and patient compliance with treatment recommendations are problematic. Pediatric issues include those specific to evaluation, projected growth, and surgery. Strict activity modification can protect the knee from further injury and delay surgery, sometimes until maturity. Surgical options include physeal-sparing, partial transphyseal, and complete transphyseal procedures. Surgical procedures are demanding because typical drilling and fixation techniques can affect the physis and possibly lead to growth disturbances. A wide range of growth disturbances has been reported; these must be understood to perfect surgical technique and avoid potential growth concerns. Surgical challenges, options regarding delayed surgery, and possible outcomes all need to be clearly communicated to the patient and parents.






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Copyright © 2006 by the American Academy of Orthopaedic Surgeons.