Brief Overview of Surgical Anterior Cruciate Ligament Options: Algorithm Based on Skeletal Age
Frank A. Cordasco
Daniel W. Green
THE AUTHORS’ SURGICAL TREATMENT ALGORITHM
Our surgical treatment algorithm is outlined in the following text. When an anterior cruciate ligament (ACL) tear is confirmed clinically in the pediatric or adolescent athlete, magnetic resonance imaging (MRI) is used to determine the presence of associated pathology and to evaluate the distal femoral and proximal tibial physes. The skeletally immature athlete is then treated immediately with the initiation of activity modification, bracing, and rehabilitation.
Steps 1 and 2
The patient’s physiologic age is determined with use of the methods described in Chapter 38. These methods include a posteroanterior (PA) radiograph of the left hand, an MRI as mentioned earlier, and standing hip/knee/ankle radiographs to assess for limb length discrepancy and alignment.
The Hospital for Special Surgery (HSS) Shorthand Bone Age Measurement Scale (Fig. 11.1A) is used to determine skeletal age, and the projected remaining growth can be assessed using Anderson-Green growth charts (Fig. 11.1B) as well as other methods (see Chapter 38 for further details).
The natural history of nonoperative treatment in the ACL-injured skeletally immature athlete has been reviewed completely in Chapters 2 and 5. The indication for ACL reconstruction is predicated on clinical instability, associated intra-articular pathology, the patient’s activity level and goals, and skeletal age and growth remaining.Related posts:
Technique: Modified McIntosh
Postoperative Rehabilitation for Pediatric and Adolescent Anterior Cruciate Ligament Reconstruction
Rehabilitation following Patellar Instability
Osteochondral Autograft Transplantation/Allograft
Tibial Spine/Anterior Cruciate Ligament Avulsion Fractures Overview Technique Suture
Surgical Treatment of Growth Arrest
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