Pediatric Anterior Cruciate Ligament Reconstruction: A Reason Not to Wait Until Skeletal Maturity

Anterior cruciate ligament (ACL) tears within the skeletally immature population give rise to controversy regarding the timing of treatment decisions due to the concern of iatrogenic damage to the open physis. Physis disruption from the required intraoperative graft tunnel drilling can lead to growth disturbance, thus ligament reconstruction is not without risk. Nonoperative management carries the risk of future damage to the menisci and cartilage as an ACL-deficient knee can be unstable. This particular case of a skeletally immature 10-year old male demonstrates an initial course of nonoperative treatment which ultimately resulted in previously undiagnosed meniscal damage. Failure of the nonoperative treatment was followed by a successful ACL reconstruction and meniscal repair surgery utilizing a partial physeal sparing technique. The patient successfully returned to his preoperative activity level without any graft disruption, postoperative indications of meniscus pathology, or abnormal growth deformities. This case report adds to the current literature reporting successful and safe ACL reconstructions in a skeletally immature patient.