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Published on: March 26, 2015
Surgical-experimental principles of anterior cruciate ligament (ACL) reconstruction with open growth plates
Romain Seil1,2, Frederick K Weitz3, Dietrich Pape4,5
1Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg, Clinique d'Eich. 78, rue d'Eich, L-1460, Luxembourg, Luxembourg. rseil@yahoo.com.
Insights
Pediatric anterior cruciate ligament (ACL) reconstruction is safe in animal models, with identified risk factors and surgical principles to prevent growth abnormalities. Further long-term human studies are needed for complete understanding.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Sports medicine
Background:
- Lack of international guidelines for pediatric ACL injuries creates treatment challenges.
- Extensive research, including animal studies, has explored ACL reconstruction in skeletally immature patients with open growth plates.
Purpose of the Study:
- To review surgical and animal experimental studies on pediatric ACL reconstruction in the presence of open growth plates.
- To identify key factors influencing outcomes and safety in this patient population.
Main Methods:
- Review of existing literature and synthesis of animal experimental data.
- Identification of 15 specific points related to pediatric ACL reconstruction.
- Analysis of growth abnormalities, risk factors, and biological healing in pediatric ACL surgery.
Main Results:
- Pediatric ACL reconstruction demonstrated safety in animal models.
- Specific risk factors and biological healing factors were identified.
- Surgical principles for safe pediatric ACL reconstruction were deduced, potentially preventing significant growth disturbances.
Conclusions:
- Technically sound pediatric ACL reconstruction carries minimal risk of significant growth abnormalities.
- Animal studies support the safety, though direct human generalization requires caution.
- Long-term follow-up is crucial to fully elucidate risks associated with ACL surgery in patients with open growth plates.
Objective:
To review surgical and animal experimental studies performed with open growth plates in relation with pediatric anterior cruciate ligament (ACL) reconstruction.
Backround:
When it comes to the treatment of ACL injured children, there is a lack of current international guidelines, leaving the treating physicians with a therapeutic dilemma. A variety of surgical and animal experimental studies have been undertaken over the last decades in relation with open growth plates and ACL-reconstruction.
Method:
Based on our own previous animal experimental data, we highlighted 15 specific points concerning pediatric ACL-reconstruction and reviewed additional literature concerning these individual items.
Results:
Pediatric ACL-reconstruction could be proven to be safe in animal models. Growth abnormalities, risk factors and factors, which were specifically related to biological healing processes in children, were identified. From them surgical principles for safe pediatric ACL replacements can be deducted. Applying these principles through a correct technical execution of surgery may prevent clinically significant growth changes.
Conclusion:
Over the last 2 decades it has been shown that a technically correct pediatric ACL reconstruction has little risk in creating clinically significant growth abnormalities. Animal experiments support this hypothesis despite the fact that the gained knowledge cannot be fully generalized to humans. More long time follow-up is needed to fully understand the complete risk factors related to ACL surgery with open growth plates.
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