Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 18, Issue 11, pp 1496–1500 | Cite as

Growth disturbances without growth arrest after ACL reconstruction in children

  • Franck Chotel
  • Julien Henry
  • Romain Seil
  • Julien Chouteau
  • Bernard Moyen
  • Jérôme Bérard


Growth arrest is a major concern after ACL reconstruction in children. It usually occurs in patients near to closure of the growth plates. Growth disturbances without growth arrest are also possible and more vicious; the authors analyse the mechanism of two patients with growth disturbance due to overgrowth following ACL reconstruction. One was a symmetrical overgrowth process with 15 mm limb length discrepancy treated with percutaneous epiphysiodesis. Full correction at the time of skeletal maturity was achieved. The second patient developed an asymmetrical overgrowth with progressive tibial valgus deformity. This mechanism was similar to a posttraumatic tibial valgus deformity. After nonoperative treatment, a spontaneous correction of the deformity was noticed. Both children were young (7 and 10 years old) at the time of ACL reconstruction with an autologous iliotibial band graft. The clinical relevance of overgrowth disturbance is usually limited when compared to growth arrest but could require a second surgical procedure as reported in this study. Parents must be informed that even in experienced hands, and despite the use of a physeal sparing technique, this specific risk of growth disturbance is still present.


Anterior cruciate ligament Reconstruction Children Growth disturbance Overgrowth Skeletally immature 


  1. 1.
    Aichroth PM, Patel DV, Zorrilla P (2002) The natural history and treatment of rupture of the anterior cruciate ligament in children and adolescents. A prospective review. J Bone Joint Surg Br 84:38–41CrossRefPubMedGoogle Scholar
  2. 2.
    Anderson M, Green WT, Messner MB (1963) Growth and predictions of growth in the lower extremities. J Bone Joint Surg Am 45:1–14Google Scholar
  3. 3.
    Ashraf N, Meyer MH, Frick S et al (2007) Evidence for overgrowth after midfemoral fracture via increased RNA for mitosis. Clin Orthop Relat Res 454:214–222CrossRefPubMedGoogle Scholar
  4. 4.
    Bonnard C, Chotel F (2007) Knee ligament and meniscal injury in children and adolescents. Rev Chir Orthop Reparatrice Appar Mot 93:95–139PubMedGoogle Scholar
  5. 5.
    Bylski-Austrow DI, Wall EJ, Rupert MP et al (2001) Growth plate forces in adolescent human knee: a radiographic and mechanical study of epiphyseal staples. J Pediatr Orthop 21:817–823CrossRefPubMedGoogle Scholar
  6. 6.
    Chotel F, Mottier F, Bonnard C et al (2007) Enquête de pratique sur la prise en charge de la rupture du LCA de l’enfant par les chirurgiens orthopédistes français. In : les lésions ligamentaires et méniscales du genou de l’enfant et de l’adolescent. Rev Chir Orthop Reparatrice Appar Mot 93:117–120Google Scholar
  7. 7.
    Edwards TB, Greene CC, Baratta RV et al (2001) The effect of placing a tensioned graft across open growth plates. A gross and histologic analysis. J Bone Joint Surg Am 83:725–734PubMedGoogle Scholar
  8. 8.
    Gebhard F, Ellermann A, Hoffmann F et al (2006) Multicenter-study of operative treatment of intraligamentous tears of the anterior cruciate ligament in children and adolescents. Knee Surg Sports Traumatol Arthrosc 14:797–803CrossRefPubMedGoogle Scholar
  9. 9.
    Green NE (1983) Tibia valga caused by asymmetrical overgrowth following a nondisplaced fracture of the proximal tibia metaphysis. J Pediatr Orthop 3:235–237PubMedGoogle Scholar
  10. 10.
    Guzzanti V, Falciglia F, Stanitski CL (2003) Physeal-sparing intraarticular anterior cruciate ligament reconstruction in preadolescents. Am J Sports Med 31:949–953PubMedGoogle Scholar
  11. 11.
    Heck RK Jr, Sawyer JR, Warner WC et al (2008) Progressive valgus deformity after curettage of benign lesions of the proximal tibia. J Pediatr Orthop 28:757–760PubMedGoogle Scholar
  12. 12.
    Henry J, Chotel F, Chouteau J et al (2009) Rupture of the anterior cruciate ligament in children: early reconstruction with open physes or delayed reconstruction to skeletal maturity? Knee Surg Sports Traumatol Arthrosc 17:48–55CrossRefGoogle Scholar
  13. 13.
    Houle JB, Letts M, Yang J (2001) Effects of a tensioned tendon graft in a bone tunnel across the rabbit physis. Clin Orthop Relat Res 391:275–281CrossRefPubMedGoogle Scholar
  14. 14.
    Jawish R, Kahwaji A, Dagher G (2003) Overgrowth of the femoral fractures in childhood. Rev Chir Orthop Reparatrice App Mot 89:404–406Google Scholar
  15. 15.
    Kocher MS, Saxon HS, Hovis WD et al (2002) Management and complications of anterior cruciate ligament injuries in skeletally immature patients: survey of the herodicus society and the ACL study group. J Pediatr Orthop 22:452–457CrossRefPubMedGoogle Scholar
  16. 16.
    McCarthy JJ, Kim DH, Eilert RE et al (1998) Posttraumatic genu valgum: operative versus non operative treatment. J Pediatr Orthop 18:518–521CrossRefPubMedGoogle Scholar
  17. 17.
    McIntosh AL, Dahm DL, Stuart MJ (2006) Anterior cruciate ligament reconstruction in the skeletally immature patient. Arthroscopy 22:1325–1330CrossRefPubMedGoogle Scholar
  18. 18.
    Meller R, Kendoff D, Hankemeier S et al (2008) Hindlimb growth after a transphyseal reconstruction of the anterior cruciate ligament: a study in skeletally immature sheep with wide-open physes. Am J Sports Med 12:2437–2443CrossRefGoogle Scholar
  19. 19.
    Millett PJ, Willis AA, Warren RF (2002) Associated injuries in pediatric and adolescent anterior cruciate ligament tears: does a delay in treatment increase the risk of meniscal tear? Arthroscopy 18:955–959CrossRefPubMedGoogle Scholar
  20. 20.
    Nakhostine M, Bollen SR, Cross MJ (1995) Reconstruction of mid-substance anterior cruciate rupture in adolescents with open physes. J Pediatr Orthop 15:286–287PubMedGoogle Scholar
  21. 21.
    Ono T, Wada Y, Takahashi K et al (1998) Tibial deformities and failures of anterior cruciate ligament reconstruction in immature rabbits. J Orthop Sci 3:150–155CrossRefPubMedGoogle Scholar
  22. 22.
    Sabharwal S, Zhao C, Edgar M et al (2008) Lower limb alignment in children. Reference values based on a full-length standing radiograph. J Pediatr Orthop 28:740–746PubMedGoogle Scholar
  23. 23.
    Seil R, Pape D, Kohn D (2008) The risk of growth changes during transphyseal drilling in sheep with open physes. Arthroscopy 24:824–833CrossRefPubMedGoogle Scholar
  24. 24.
    Shapiro F (1981) Fractures of the femoral shaft in children. The overgrowth phenomenon. Acta Orthop Scand 52:649–655CrossRefPubMedGoogle Scholar
  25. 25.
    Shea KG, Pfeiffer R, Wang JH et al (2004) Anterior cruciate ligament injury in pediatric and adolescent soccer players: an analysis of insurance data. J Pediatr Orthop 24:623–628PubMedGoogle Scholar
  26. 26.
    Sisk TD (1992) Knee injuries. Campbell’s operative orthopaedics. Mosby Year Book, St Louis, pp 1576–1578Google Scholar
  27. 27.
    Sulaiman AR, Joehaimy J, Iskandar MA et al (2006) Femoral overgrowth following plate fixation of the fractured femur in children. Singapore Med J 47:684–687PubMedGoogle Scholar
  28. 28.
    Tuten HR, Keeler KA, Gabos PG et al (1999) Posttraumatic tibia valga in children. A long-term follow-up note. J Bone Joint Surg Am 81:799–810PubMedGoogle Scholar
  29. 29.
    Wessel LM, Scholz S, Rusch M et al (2001) Hemarthrosis after trauma to the pediatric knee joint: what is the value of magnetic resonance imaging in the diagnostic algorithm? J Pediatr Orthop 21:338–342CrossRefPubMedGoogle Scholar
  30. 30.
    Zionts LE, Harcke HT, Brooks KM et al (1987) Posttraumatic tibia valga: a case demonstrating asymmetric activity at the proximal growth plate on technetium bone scan. J Pediatr Orthop 7:458–462PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Franck Chotel
    • 1
  • Julien Henry
    • 2
  • Romain Seil
    • 3
  • Julien Chouteau
    • 2
  • Bernard Moyen
    • 2
  • Jérôme Bérard
    • 1
  1. 1.Service de Chirurgie Orthopédique Pédiatrique, Hôpital Universitaire Femme Mère Enfant de LyonUniversité Claude Bernard Lyon IBronFrance
  2. 2.Service de chirurgie orthopédique, de traumatologie et de médecine du sportCentre Hospitalier Lyon-SudPierre Bénite, CedexFrance
  3. 3.Service de Chirurgie Orthopédique, Centre de l’Appareil Locomoteur de Médecine du Sport et de PréventionCentre Hospitalier de Luxembourg-Clinique d’EichLuxembourgLuxembourg

Personalised recommendations