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Growth Stimulation Following an All-Epiphyseal Anterior Cruciate Ligament Reconstruction in a Child: A Case Report.

Over the past decade, there has been a substantial increase in the number of reported intrasubstance tears of the anterior cruciate ligament (ACL) in children younger than twelve years of age or in prepubescent children1-6. Multiple studies have emphasized the need for early ACL reconstruction in skeletally immature patients to prevent the development of meniscal tears and early knee arthrosis7-10. The native ACL in children always courses from the distal femoral epiphysis to the proximal tibial epiphysis. If the usual ACL reconstruction used in adults is performed on a child or adolescent, this anatomy becomes problematic because tunnels are drilled through the growth plates into the distal part of the femur and the proximal tibial metaphyses. In children with wide-open growth plates, a solidly fixed and tensioned graft, placed as in adults, may potentially cause a “tether effect” that can retard growth at these growth plates11,12. In order to avoid tether or bone-bar formation, multiple partial or complete physeal-sparing techniques to reconstruct the ACL in this age group have been proposed1,6,13-16.

Growth disturbance, especially growth arrest, has been a major concern with the surgical management of intrasubstance ACL tears in growing children and adolescents12,15,17-20. In contrast, limb overgrowth is a theoretical possibility following any long-bone surgery in a child. To our knowledge, there are no reported cases of clinically significant limb overgrowth that required surgical epiphysiodesis as a consequence of a physeal-sparing or an all-epiphyseal ACL reconstruction in a child. This case is reported to alert physicians, patients, and their parents that overgrowth requiring surgical correction can occur after ACL reconstruction in a skeletally immature child. The patient and his parents were …