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Growth Arrest of the Tibia After Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) injury in skeletally immature patients is associated with a poor prognosis related to meniscal and chondral injury. In addition to the usual risks of surgery, growth arrest of open physes must also be considered when ACL reconstruction is performed for these patients. Although the initial treatment of a very skeletally immature patient with an acute ACL injury remains controversial, surgery is indicated for recurrent instability. Standard bone tunnels and fixation methods using a soft tissue allograft or autograft are thought to be the most effective technique in the adult population because it provides the most accurate anatomical reconstruction of the ligament. Adolescents who are near skeletal maturity and who have limited growth remaining are at a minimal risk of developing a deformity with standard bone tunnels and fixation methods, even if they sustain a partial physeal arrest. Performing transphyseal ACL reconstruction on children with wide open physes has a similar benefit, although it carries some increased risk of physeal growth plate damage. Consequently, some surgeons attempt all-epiphyseal or over the top/over the front techniques to avoid drilling holes in the distal femoral and proximal tibial physes. This report documents a case of severe tibial deformity and shortening after transphyseal ACL reconstruction. Lengthening and correction of the deformity were accomplished with the Taylor Spatial Frame.