Abstract
A dramatic rise in youth competitive athletic activity and year-round training and competition, along with an increased awareness of ACL injuries in children, has led to a commensurate increase in the frequency of ACL tears in the skeletally immature. Recent understanding of the risks of nonoperative treatment and surgical delay has supported a trend toward early operative treatment. In prepubescent patients, unique anatomy and considerable remaining skeletal growth make physeal-respecting ACL reconstruction challenging. This is significantly more difficult in the smallest knees with congenital ACL absence. Herein we discuss the indications, surgical technique, aftercare, and clinical outcomes after ACL reconstruction without bone tunnels, using an iliotibial band autograft technique.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Dodwell ER, Lamont LE, Green DW, Pan TJ, Marx RG, Lyman S. 20 years of pediatric anterior cruciate ligament reconstruction in New York state. Am J Sports Med. 2014;3:675–80.
Anderson AF, Anderson CN. Correlation of meniscal and articular cartilage injuries in children and adolescents with timing of anterior cruciate ligament reconstruction. Am J Sports Med. 2015;2:275–81.
Dumont GD, Hogue GD, Padalecki JR, Okoro N, Wilson PL. Meniscal and chondral injuries associated with pediatric anterior cruciate ligament tears: relationship of treatment time and patient-specific factors. Am J Sports Med. 2012;9:2128–33.
Fabricant PD, Lakomkin N, Cruz AI, Spitzer E, Lawrence JT, Marx RG. Early ACL reconstruction in children leads to less meniscal and articular cartilage damage when compared with conservative or delayed treatment. J ISAKOS. 2016;1:10–5.
Fabricant PD, Lakomkin N, Cruz AI, Spitzer E, Marx RG. ACL reconstruction in youth athletes results in an improved rate of return to athletic activity when compared with non-operative treatment: a systematic review of the literature. J ISAKOS. 2016;2:62–9.
Lawrence JT, Argawal N, Ganley TJ. Degeneration of the knee joint in skeletally immature patients with a diagnosis of an anterior cruciate ligament tear: is there harm in delay of treatment? Am J Sports Med. 2011;12:2582–7.
Newman JT, Carry PM, Terhune EB, Spruiell MD, Heare A, Mayo M, Vidal AF. Factors predictive of concomitant injuries among children and adolescents undergoing anterior cruciate ligament surgery. Am J Sports Med. 2015;2:282–8.
MacIntosh DL, Darby TA. Lateral substitution reconstruction. In: Proceedings of the canadian orthopaedic association. J Bone Joint Surg. 1976;1:142.
Kocher MS, Garg S, Micheli LJ. Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescents. J Bone Joint Surg Am. 2005;11:2371–9.
Micheli LJ, Rask B, Gerberg L. Anterior cruciate ligament reconstruction in patients who are prepubescent. Clin Orthop Relat Res. 1999;364:40–7.
Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. J Anat. 2013;4:321–8.
Parsons EM, Gee AO, Spiekerman C, Cavanagh PR. The biomechanical function of the anterolateral ligament of the knee. Am J Sports Med. 2015;3:669–74.
Vincent JP, Magnussen RA, Gezmez F, Uguen A, Jacobi M, Weppe F, Al-Saati MF, Lustig S, Demey G, Servien E, Neyret P. The anterolateral ligament of the human knee: an anatomic and histologic study. Knee Surg Sports Traumatol Arthrosc. 2012;1:147–52.
Kennedy A, Coughlin DG, Metzger MF, Tang R, Pearle AD, Lotz JC, Feeley BT. Biomechanical evaluation of pediatric anterior cruciate ligament reconstruction techniques. Am J Sports Med. 2011;5:964–71.
Nwachukwu BU, McFeely ED, Nasreddine A, Udall JH, Finlayson C, Shearer DW, Micheli LJ, Kocher MS. Arthrofibrosis after anterior cruciate ligament reconstruction in children and adolescents. J Pediatr Orthop. 2011;8:811–7.
Akinleye SD, Sewick A, Wells L. All-epiphyseal ACL reconstruction: a three-year follow-up. Int J Sports Phys Ther. 2013;3:300–10.
Fabricant PD, McCarthy MM, Cordasco FA, Green DW. All-inside, all-epiphyseal autograft reconstruction of the anterior cruciate ligament in the skeletally immature athlete. JBJS Essent Surg Tech. 2013;2:e9.
Fabricant PD, Jones KJ, Delos D, Cordasco FA, Marx RG, Pearle AD, Warren RF, Green DW. Reconstruction of the anterior cruciate ligament in the skeletally immature athlete: a review of current concepts: AAOS exhibit selection. J Bone Joint Surg Am. 2013;5:e281–13.
Greenberg EM, Albaugh J, Ganley TJ, Lawrence JT. Rehabilitation considerations for all epiphyseal ACL reconstruction. Int J Sports Phys Ther. 2012;2:185–96.
McCarthy MM, Graziano J, Green DW, Cordasco FA. All-epiphyseal, all-inside anterior cruciate ligament reconstruction technique for skeletally immature patients. Arthrosc Tech. 2012;2:e231–9.
Kocher MS, Heyworth BE, Tepolt F, Fabricant PD, Micheli LJ. Outcomes of physeal sparing ACL reconstruction with IT band in skeletally immature children (unpublished data).
Willimon SC, Jones CR, Herzog MM, May KH, Leake MJ, Busch MT. Micheli anterior cruciate ligament reconstruction in skeletally immature youths: a retrospective case series with a mean 3-year follow-up. Am J Sports Med. 2015;12:2974–81.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Fabricant, P.D., Kocher, M.S. (2018). ACL Reconstruction Without Bone Tunnels. In: Parikh, S. (eds) The Pediatric Anterior Cruciate Ligament. Springer, Cham. https://doi.org/10.1007/978-3-319-64771-5_12
Download citation
DOI: https://doi.org/10.1007/978-3-319-64771-5_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-64770-8
Online ISBN: 978-3-319-64771-5
eBook Packages: MedicineMedicine (R0)