Early ACL Reconstruction in Children With Congenital ACL Deficiency: A Prospective Case Series

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Sports medicine

Background:

• Congenital anterior cruciate ligament (ACL) deficiency is rare, causing knee instability and potential deformities in children.
• Management is debated due to risks of ACL reconstruction in skeletally immature patients versus benefits of early stabilization.
• Physeal-sparing techniques aim to protect growth plates while addressing ACL deficiency.

Purpose of the Study:

• To evaluate the clinical outcomes of physeal-sparing ACL reconstruction in children with congenital ACL deficiency.
• To assess the safety and efficacy of this technique in restoring knee stability and function.

Main Methods:

• A prospective case series of 22 children (24 knees) aged 3-13 years with congenital ACL deficiency.
• Arthroscopic-assisted ACL reconstruction using an iliotibial band autograft with a modified MacIntosh technique.
• Pre- and postoperative clinical exams, radiographs, and MRI; follow-up of 6-15 months.

Main Results:

• 91.7% of knees achieved stability with negative Lachman and pivot-shift tests at follow-up.
• MRI confirmed intact grafts in 92% of knees; full range of motion was preserved in most.
• No growth disturbances or angular deformities observed; complications were limited to 2 superficial infections.

Conclusions:

• Early physeal-sparing ACL reconstruction is safe and effective for congenital ACL deficiency in children.
• The iliotibial band technique restores stability and supports early surgical intervention for symptomatic patients.
• This approach may protect the developing knee and facilitate future reconstructive procedures.