Pediatric Anterior Cruciate Ligament Reconstruction

Introduction

Video 20.1 Pediatric Anterior Cruciate Ligament Reconstruction. Davide Edoardo Bonasia, MD; Roberto Rossi, MD; Brian R. Wolf, MD; Annunziato Amendola, MD (18 min)

Patient Selection

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  Clinical examination
  

  
  
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    History—Audible pop, rapid-­onset hemarthrosis
    
    
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    Mechanism—Flexion-­valgus-­external rotation is most common
    
    
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    Evaluate joint effusion, point tenderness, range of motion (ROM), and instability
    
    
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    Perform Lachman, drawer, pivot-­shift, and varus/valgus stress tests
  
  
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  Conservative treatment
  

  
  
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    Includes ROM exercises, strengthening, functional braces, and activity modification
    
    
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    Conservative management should be discussed in all cases, especially for inactive patients
  
  
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  Surgical indications
  

  
  
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    Failure of conservative treatment with persistent effusion, pain, instability
    
    
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    Patient is unwilling or unable to modify activity levels
    
    
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    Meniscal tear is associated with ACL tear.
  
  
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  Patient age
  

  
  
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    In older adolescents (females older than 14 years; males older than 16 years), a complete transphyseal technique can be used
    
    
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    In younger patients (females younger than 14 years; males younger than 16 years), technique selected based on surgeon preference
    
    
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    Authors’ preference—Partial transphyseal technique with proximal over-­the-­top positioning of semitendinosus tendon autograft

Preoperative Imaging

Radiography

Magnetic Resonance Imaging