Arthroscopic All-Epiphyseal Reconstruction for Pediatric ACL Tears

Dr. Steven Chudik explains the growth plate sparing ACL reconstruction surgery procedure he developed.

Research-ACL Reconstruction with Open Growth Plates

Anterior cruciate ligament (ACL) injury in the skeletally immature individual is being recognized with increasing frequency. Historically, nonoperative treatment of midsubstance ACL injuries in skeletally immature individuals has not been favorable. Despite many reports of successful ACL reconstruction, many orthopaedic surgeons still are reluctant to perform ACL reconstructive procedures in the skeletally immature individual because of clinical reports of subsequent growth abnormalities and a general lack of understanding regarding the physiologic consequences of ACL reconstruction in these patients.

Current clinical studies support the use of anatomic ACL reconstructive techniques via either paraphyseal, transphyseal, or epiphyseal graft positioning with either metaphyseal or epiphyseal graft fixation. Although there is a consensus that reconstructions via fixation devices or bone grafts that traverse the physis carry a high risk for growth abnormalities and are inappropriate, it is not known which technique of ACL reconstruction provides the least risk and best restores the anatomy and function of the ACL in the growing child.

From the results of our study, we cannot advocate any single femoral reconstructive technique. An epiphyseal femoral technique may reduce the risk of angular deformity and allow a more optimal femoral graft position after growth as opposed to transphyseal and over-the-top techniques. However, the epiphyseal technique may possess an increased risk for rotational deformity, physeal injury, and articular surface injury.

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