Le lesioni del legamento crociato anteriore del ginocchio del paziente in accrescimento

Abstract

ACL injuries in prepubescent patients are being seen with increasing frequency. The reasons include intensive year round training regimens and early sport specialisation, but also a more precise diagnosis of the trauma and its causes. The traditional treatment was conservative, but with poor outcomes and an high rate of chondral and articular damages caused by prolonged instability. As a result, there is the need for surgical anterior cruciate reconstruction even in skeletally immature patients. Many surgical techniques have been described to achieve a physeal sparing reconstruction, thus avoiding iatrogenic damages of the limb growth. The proposed techniques can be divide into three groups: extra-epiphyseal, trans-epiphyseal and all-epiphyseal. Some issues are related to the non-anatomical stabilisation achieved with the extra-epiphyseal reconstruction. All-epiphyseal reconstruction, which involves some technical complexities, should be preferred in younger patients with fully open physes. The trans-epiphyseal approach has shown satisfactory outcomes in patients with older skeletal age, reducing the surgical impact on growth cartilages with some technical adjustments if compared with the usual technique for adults.