ACL Reconstruction for Open Physes Patient

Abstract

Introduction: Participation of young athletes contributes to increment of ACL tears cases in children and adolescence. Management of ACL tears in that age group remains debatable. Traditionally, patients with immature bone have been treated without surgery or delayed reconstructive surgery to prevent iatrogenic growth retardation due to epiphyseal injury. However, conservative management showed poor results, the patient subsequently developed recurrent knee instability leading to progressive intraarticular damage, including secondary meniscus and chondral injuries. Special reconstruction technique is required to maintain the growth plate. The purpose of this study is to point out reconstruction technique available on managing ACL rupture. Method: This presentation review does systematic evidence based on literature review of management of ACL injury in skeletal immature patient. Results: There are some techniques that can be performed for paediatric patients are physeal sparing, with iliotibial band reconstruction, ACL reconstruction with all-epiphyseal tunnels and post distal fixation, all-epiphyseal tunnels reconstruction and fixation, partial transphyseal technique, and trans-physeal technique. The surgical technique was determined based on maturity and bone age using Tanner staging and hand radiographs. In pre pubertal patients, Tanner stage 1 or 2 (boys 12 years and girls 11 years) was performed using a physeal sparing. Young adolescents are still in their infancy, Tanner stage 3 or 4, boys 13-16 years old, it is better to have ACL reconstruction done with partial transphyseal or transphyseal technique. Older adolescents with physeal closure (males 15 years and girls 14 years) ACL reconstruction were performed as in adult patients. Discussion: The choice of reconstruction technique in pediatric patients is based on the maturity and bone age of the child. In the pre-pubertal period with Tanner stage 1 or 2 experiments can be carried out non-operative measures followed by physeal sparing reconstruction, young adolescents are still in their infancy, transphyseal reconstruction is carried out, reconstruction in older adolescents is carried out as in adults. Some consideration makes decision whether not to operate or operate the patient. Concerns regarding injury to physic, leg length discrepancy, and source of graft led the innovation of the surgical technique to reconstruct the ACL.