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ACL reconstruction technique improves outcomes in pediatric patients
Date:7/12/2012

the knee, holes are drilled through the ends of the thighbone and shinbone, and a tissue graft is inserted in place of the removed ligament. In this way, the reconstruction mimics the natural ACL footprint. ACL reconstruction is difficult in children because if an adult-type reconstruction were performed, the graft would cross the growth plates, potentially causing damage that can result in uneven limb lengths or angular deformities. Thus, for many years, ACL injuries in children were managed with benign neglect, or surgical procedures that were not anatomic and required large incisions to avoid injuring the growth plate. In recent years, however, clinicians realized that non-operative treatment resulted in damage to menisci and articular cartilage thereby leading to early arthritis. Advances in technology, instrumentation and techniques are now available which allow surgeons to perform the AE reconstruction without risk of injury to the growth plate. These procedures are more technically demanding and are available at only a few centers around the country including HSS.

In the study, researchers, including Dr. Cordasco and HSS pediatric orthopedic surgeon Daniel Green, M.D., compared two ACL reconstruction techniques for children that minimize contact with the growth plate: the AE technique and the over-the-top reconstruction (OT). In the OT, surgeons slide a graft through a hole drilled into the shinbone, similar to an adult ACL surgery, but the graft is then attached to the back of the thighbone. The OT requires an open incision and does not mimic the natural ACL footprint. In the AE, surgeons mimic the adult surgery, but the ligament is only attached to the epiphysis and does not cross into the growth plate. The AE is performed arthroscopically and mimics the natural ACL footprint. While the AE has been around for ten years, it has been drastically refined in the last few years, due to advances in arthroscopic technologies.

The researchers ob
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Contact: Phyllis Fisher
fisherp@hss.edu
212-606-1197
Hospital for Special Surgery
Source:Eurekalert

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