Posterior Cruciate and Posterolateral Ligament Reconstruction in an Adolescent with Open Physes

Abstract

Intrasubstance tears of the posterior cruciate ligament and posterolateral structures of the knee, a relatively common injury in adults, are very rare in children and adolescents. Most injuries of the posterior cruciate ligament in this age-group are osteochondral avulsions of either the femoral or tibial attachment1-12. When nonoperative treatment or primary repair of a torn or avulsed posterior cruciate ligament fails and a child or adolescent experiences instability, meniscal damage, and early degenerative changes, the physician is confronted with a dilemma: continued nonoperative treatment will probably result in progressive deterioration of the knee, but surgical intervention may cause an iatrogenic physeal injury. We report the case of an adolescent patient with posterior instability and posterolateral instability of the knee for whom nonoperative treatment had failed and who was successfully treated with use of a physeal sparing intra-articular reconstruction of the posterior cruciate ligament and an extra-articular reconstruction of the posterolateral structures. The patient's family was informed that data concerning the case would be submitted for publication. The patient sustained a hyperextension injury of the right knee while jumping on a trampoline when he was eight years old. He was initially seen by a local physician who made a diagnosis of a sprained knee. The pain and swelling of the knee gradually subsided without treatment. He sustained a second injury of the right knee while playing football when he was eleven years and eight months old. Magnetic resonance imaging revealed partial tears of the anterior and posterior cruciate ligaments and a medial meniscal tear. Arthroscopy, which was performed at another institution, revealed a small radial tear in the white zone of the medial meniscus with an unstable component, and approximately 10% of the meniscus was excised. The articular surfaces of the medial femoral condyle and the medial …