Conference Report - ACL Injury and Open Physes in the Young Athlete

Don Johnson, MD, FRCS(C)

In This Article


More children are now involved in organized sports. This increase in participation and the pressure placed on the child by parents and coaches has resulted in an increase in the number of sports-related injuries, especially anterior cruciate ligament (ACL) injuries. Popular activities such as soccer and basketball lend themselves to this type of injury. Because ACL injuries are recognized quicker, due to increased awareness and better diagnostic tools, such as magnetic resonance imaging (MRI), more physicians are treating ACL injuries in children and adolescents whose physes are open.

In an adult, conservative treatment consists of using a brace while playing sports and surgical treatment consists of reconstructing the ligament. Conservative treatment in children with open physes requires not only using a brace while playing sports but also avoiding all sports that require cutting and pivoting. The danger of nonoperative treatment is that the child will continue to be active, despite precautions, resulting in irreparable meniscal tears and damage to the articular surface. Shelbourne and Gray[1] have shown that 97% of knees with a normal meniscus and articular surface at the time of reconstruction will have normal x-ray examination results at 10 years. It appears that one should reconstruct the ACL to preserve the menisci and protect the joint.

However, using surgical intervention in skeletally immature children was questioned after a case report by Koman and Sanders[2] was published. They described a valgus deformity after an ACL reconstruction in a young adult. In this case report, a 14-year-old patient had a soft tissue graft that was augmented in the tibial and femoral tunnels with a bone graft across the epiphysis. The distal femoral epiphysis fused and resulted in a valgus deformity 2 years later.

The latest thinking in the literature on the risks and benefits of surgical intervention and the results of relevant data presented at the American Orthopaedic Society for Sports Medicine (AOSSM) 29th Annual Meeting are discussed in this article.


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