Anatomical and technical considerations for pediatric ACL reconstruction. In Controversies in the technical aspects of ACL reconstruction: An evidence-based medicine approach. (Book Chapter)

The objective of this chapter is to give a comprehensive overview of anatomical and technical issues of anterior cruciate ligament (ACL) reconstruction in children with open growth plates. 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. Several surgical techniques have been described to perform the best possible ACL replacement in children with open growth plates. All these bear a specific risk to the growth plate. In addition, anatomic graft placement is difficult due to the presence of the growth plates. The current literature concerning ACL reconstruction in skeletally immature patients and the experimental animal model research is analyzed, and some of the most commonly used operative techniques and their specific risks are presented. Potential complications and their treatment are discussed. ACL reconstruction in skeletally immature patients is a highly demanding procedure. Although technically correct pediatric ACL reconstruction has little risk in creating growth abnormalities, the operative treatment and follow-up until the end of knee growth should be performed in specialized institutions.