Current trends in ACL repair: Primary repair, mechanical augmentation and biological supplementation

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page:36-40 | Rajeev Raman, Bibhuti Nath Mishra

Author: Rajeev Raman [1], Bibhuti Nath Mishra [2]

[1] Consultant Orthopaedic Surgeon, Joint & Bone Care Hospital, Salt Lake City, Kolkata, India
[2] Consultatnt Orthopaedic Surgeon, Birat Medical College Teaching Hospital, Biratnagar, Nepal.

Address of Correspondence
Dr. Bibhuti Nath Mishra,
Birat Medical College Teaching Hospital, Biratnagar, Nepal


Anterior Cruciate Ligament (ACL) tear is one amongst frequent knee injuries. This injury is troublesome as it causes instability of knee while walking/running and also predisposes to the risk of early osteoarthritis in long run. So, its proper management is important, but has always remained debatable and controversial as well. Advancements in tissue engineering and regenerative medicine has changed the understanding of ACL’s anatomy and it’s healing potential and thus a renewed interest has emerged towards ACL repair again over the established gold standard “ACL reconstruction”. Novel techniques like bridging with fiber tapes, Internal Brace Ligament Augmentation (IBLA), and Dynamic Intraligamentary Stabilization (DIS) have emerged focusing on mechanical strength. Also, supplements like bio-scaffolds, platelets & platelet rich plasma (PRP) are in the offing to aid biological ligamentous healing. We will present review of past practice, current trend and future prospects of ACL repair.
Keywords: Anterior Cruciate Ligament, Repair, Reconstruction, Augmentation, Supplementation


1. Zlotnicki JP, Naendrup J-H, Ferrer GA, Debski RE. Basic biomechanic principles of knee instability. Curr Rev Musculoskelet Med. 2016 Jun;9(2):114–22.
2. Gianotti SM, Marshall SW, Hume PA, Bunt L. Incidence of anterior cruciate ligament injury and other knee ligament injuries: A national population-based study. J Sci Med Sport. 2009 Nov;12(6):622–7.
3. Lasceski C, Nacca C, Shah SS, Richmond JC. Thoughts on Anterior Cruciate Ligament Surgery over the Past 40 Years: Back to the Future. 2020;5(1):6.
4. Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR. Fate of the ACL-injured Patient: A Prospective Outcome Study. Am J Sports Med. 1994 Sep;22(5):632–44.
5. Kiapour AM, Murray MM. Basic science of anterior cruciate ligament injury and repair. Bone Jt Res. 2014 Feb;3(2):20–31.
6. Engebretsen L, Benum P, Fasting O, Mølster A, Strand T. A prospective, randomized study of three surgical techniques for treatment of acute ruptures of the anterior cruciate ligament. Am J Sports Med. 1990 Nov;18(6):585–90.
7. Hewett TE, Di Stasi SL, Myer GD. Current Concepts for Injury Prevention in Athletes After Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2013 Jan;41(1):216–24.
8. Ardern CL, Webster KE, Taylor NF, Feller JA. Return to the Preinjury Level of Competitive Sport After Anterior Cruciate Ligament Reconstruction Surgery: Two-thirds of Patients Have Not Returned by 12 Months After Surgery. Am J Sports Med. 2011 Mar;39(3):538–43.
9. Musahl V, Becker R, Fu FH, Karlsson J. New trends in ACL research. Knee Surg Sports Traumatol Arthrosc. 2011 Dec;19(S1):1–3.
10. Shelbourne KD, Gray T, Haro M. Incidence of Subsequent Injury to Either Knee within 5 Years after Anterior Cruciate Ligament Reconstruction with Patellar Tendon Autograft. Am J Sports Med. 2009 Feb;37(2):246–51.
11. Spindler KP, Huston LJ, Wright RW, et al. The prognosis and predictors of sports function and activity at minimum 6 years after anterior cruciate ligament reconstruction: a population cohort study. Am J Sports Med 2011;39:348–359.
12. Mahapatra P, Horriat S, Anand BS. Anterior cruciate ligament repair – past, present and future. J Exp Orthop. 2018 Dec;5(1):20.
13. Feagin JA, Abbott HG, Rokous JA. The isolated tear of the anterior cruciate ligament. J Bone Joint Surg Am. 1972;54(6):1340-1341.
14. Davarinos N, O’Neill BJ, Curtin W. A Brief History of Anterior Cruciate Ligament Reconstruction. Adv Orthop Surg. 2014 Apr 17;2014:1–6.
15. Feagin JA, Curl WW. Isolated tear of the anterior cruciate ligament: 5-year follow-up study. Am J Sports Med. 1976 May;4(3):95–100.
16. Taylor DC, Posner M, Curl WW, Feagin JA. Isolated Tears of the Anterior Cruciate Ligament: Over 30-Year Follow-up of Patients Treated with Arthrotomy and Primary Repair. Am J Sports Med. 2009 Jan;37(1):65–71.
17. Kaplan N, Wickiewicz TL, Warren RF. Primary surgical treatment of anterior cruciate ligament ruptures: A long-term follow-up study. Am J Sports Med. 1990 Jul;18(4):354–8.
18. GRØNTVEDT, TORBJØRN, M.D.†; ENGEBRETSEN, LARS, M.D., PH.D.‡; BENUM, PÅL, M.D., PH.D.†, TRONDHEIM; FASTING, OVE, M.D.§, OSLO; MØLSTER, ANDERS, M.D., PH.D.¶; STRAND, TORBJØRN, M.D.¶, BERGEN, NORWAY A Prospective, Randomized Study of Three Operations for Acute Rupture of the Anterior Cruciate Ligament. Five-Year Follow-up of One Hundred and Thirty-one Patients*, JBJS: February 1996 – Volume 78 – Issue 2 – p 159-69.
19. ANDERSSON, CHRISTER; ODENSTEN, MAGNUS; GILLQUIST, JAN Knee Function After Surgical or Nonsurgical Treatment of Acute Rupture of the Anterior Cruciate Ligament: A Randomized Study With a Long-Term Follow-Up Period, Clinical Orthopaedics and Related Research: March 1991 – Volume 264 – Issue – p 255-263.
20. Sherman MF, Lieber L, Bonamo JR, Podesta L, Reiter I. The long-term followup of primary anterior cruciate ligament repair: Defining a rationale for augmentation. Am J Sports Med. 1991 May;19(3):243–55.
21. Kohl S, Evangelopoulos DS, Ahmad SS, Kohlhof H, Herrmann G, Bonel H, et al. A novel technique, dynamic intraligamentary stabilization creates optimal conditions for primary ACL healing: A preliminary biomechanical study. The Knee. 2014 Mar;21(2):477–80.
22. Daniels SP, van der List JP, Kazam JJ, DiFelice GS. Arthroscopic primary repair of the anterior cruciate ligament: what the radiologist needs to know. Skeletal Radiol. 2018 May;47(5):619–29.
23. van der List JP, DiFelice GS. Primary repair of the anterior cruciate ligament: A paradigm shift. The Surgeon. 2017 Jun;15(3):161–8.
24. van der List JP, Mintz DN, DiFelice GS. The Locations of Anterior Cruciate Ligament Tears in Pediatric and Adolescent Patients: A Magnetic Resonance Study. J Pediatr Orthop. 2019 Oct;39(9):441–8.
25. Palmer I: On the injuries to the ligaments of the knee joint. Acta Chir Scand Suppl 53: 1, 1938.
26. Kennedy JC, Roth JH, Mendenhall HV, Sanford JB. Presidential address: Intraarticular replacement in the anterior cruciate ligament-deficient knee. Am J Sports Med. 1980 Jan;8(1):1–8.
27. McPherson GK, Mendenhall HV, Gibbons DF, Plenk H, Rottmann W, Sanford JB, et al. Experimental mechanical and histologic evaluation of the Kennedy ligament augmentation device. Clin Orthop. 1985 Jun;(196):186–95.
28. Schabus R: Die bedeutung der augmentation fur die rekonstruktion des vorederen kreutxbandes. Acta Chir Austrica Suppl 77: 18-20, 1988.
29. Jonkergouw A, van der List JP, DiFelice GS. Arthroscopic primary repair of proximal anterior cruciate ligament tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg Sports Traumatol Arthrosc. 2019 Jan;27(1):21–8.
30. Nwachukwu BU, Patel BH, Lu Y, Allen AA, Williams RJ. Anterior Cruciate Ligament Repair Outcomes: An Updated Systematic Review of Recent Literature. Arthrosc J Arthrosc Relat Surg. 2019 Jul;35(7):2233–47.
31. McIntyre V, Hopper GP, Mackay GM. Anterior Cruciate Ligament Repair in a Professional Soccer Player Using Internal Brace Ligament Augmentation: A Case Report Focusing on Rehabilitation. Surg Technol Int. 2019 Nov 10;35:341–8.
32. Iain C Anthony GM. Anterior Cruciate Ligament Repair Revisited. Preliminary Results of Primary Repair with Internal Brace Ligament Augmentation: A Case Series. Orthop Muscular Syst [Internet]. 2015 [cited 2020 Dec 19];04(02). Available from:
33. Wilson WT, Hopper GP, Byrne PA, MacKay GM. Anterior Cruciate Ligament Repair with Internal Brace Ligament Augmentation. Surg Technol Int. 2016 Oct 26;29:273–8.
34. Heusdens CHW, Hopper GP, Dossche L, Roelant E, Mackay GM. Anterior cruciate ligament repair with Independent Suture Tape Reinforcement: a case series with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc. 2019 Jan;27(1):60–7.
35. Smith JO, Yasen SK, Palmer HC, Lord BR, Britton EM, Wilson AJ. Paediatric ACL repair reinforced with temporary internal bracing. Knee Surg Sports Traumatol Arthrosc. 2016 Jun;24(6):1845–51.
36. Häberli J, Henle P, Acklin YP, Zderic I, Gueorguiev B. Knee joint kinematics with dynamic augmentation of primary anterior cruciate ligament repair – a biomechanical study. J Exp Orthop. 2016 Dec;3(1):29.
37. Bieri KS, Scholz SM, Kohl S, Aghayev E, Staub LP. Dynamic intraligamentary stabilization versus conventional ACL reconstruction: A matched study on return to work. Injury. 2017 Jun;48(6):1243–8.
38. Henle P, Röder C, Perler G, Heitkemper S, Eggli S. Dynamic Intraligamentary Stabilization (DIS) for treatment of acute anterior cruciate ligament ruptures: case series experience of the first three years. BMC Musculoskelet Disord. 2015 Dec;16(1):27.
39. Uchida R, Jacob G, Shimomura K, Horibe S, Nakamura N. Biological Augmentation of ACL Repair and Reconstruction: Current Status and Future Perspective. Sports Med Arthrosc Rev. 2020 Jun;28(2):49–55.
40. Drury JL, Mooney DJ. Hydrogels for tissue engineering: scaffold design variables and applications. Biomaterials. 2003 Nov;24(24):4337–51.
41. Wiig ME, Amiel D, Vandeberg J, Kitabayashi L, Harwood FL, Arfors KE. The early effect of high molecular weight hyaluronan (hyaluronic acid) on anterior cruciate ligament healing: An experimental study in rabbits. J Orthop Res. 1990 May;8(3):425–34.
42. Berry SM, Green MH, Amiel D. Hyaluronan: a potential carrier for growth factors for the healing of ligamentous tissues. Wound Repair Regen. 1997 Jan;5(1):33–8.
43. Robayo LM, Moulin VJ, Tremblay P, Cloutier R, Lamontagne J, Larkin A-M, et al. New ligament healing model based on tissue-engineered collagen scaffolds: New human ligament model. Wound Repair Regen. 2011 Jan;19(1):38–48.
44. Joshi SM, Mastrangelo AN, Magarian EM, Fleming BC, Murray MM. Collagen-Platelet Composite Enhances Biomechanical and Histologic Healing of the Porcine Anterior Cruciate Ligament. Am J Sports Med. 2009 Dec;37(12):2401–10.
45. Patinharayil G. Future trends in ACL rupture management. J Orthop. 2017 Mar;14(1):A1–4.
46. Fleming BC, Proffen BL, Vavken P, Shalvoy MR, Machan JT, Murray MM. Increased platelet concentration does not improve functional graft healing in bio-enhanced ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2015 Apr;23(4):1161–70.
47. Cheng M, Wang H, Yoshida R, Murray MM. Platelets and Plasma Proteins Are Both Required to Stimulate Collagen Gene Expression by Anterior Cruciate Ligament Cells in Three-Dimensional Culture. Tissue Eng Part A. 2010 May;16(5):1479–89.
48. Yoshida R, Murray MM. Peripheral blood mononuclear cells enhance the anabolic effects of platelet-rich plasma on anterior cruciate ligament fibroblasts: PBMCs AND PRP STIMULATE FIBROBLASTS. J Orthop Res. 2013 Jan;31(1):29–34.
49. Murray MM, Spindler KP, Devin C, Snyder BS, Muller J, Takahashi M, et al. Use of a collagen-platelet rich plasma scaffold to stimulate healing of a central defect in the canine ACL. J Orthop Res. 2006 Apr;24(4):820–30.
50. Yoshida R, Cheng M, Murray MM. Increasing platelet concentration in platelet-rich plasma inhibits anterior cruciate ligament cell function in three-dimensional culture: INCREASING PLATELET CONCENTRATION INHIBITS FIBROBLASTS. J Orthop Res. 2014 Feb;32(2):291–5.
51. Steinert AF, Kunz M, Prager P, Barthel T, Jakob F, Nöth U, et al. Mesenchymal Stem Cell Characteristics of Human Anterior Cruciate Ligament Outgrowth Cells. Tissue Eng Part A. 2011 May;17(9–10):1375–88.
52. Ge Z, Goh JCH, Lee EH. The Effects of Bone Marrow-Derived Mesenchymal Stem Cells and Fascia Wrap Application to Anterior Cruciate Ligament Tissue Engineering. Cell Transplant. 2005 Nov;14(10):763–73.
53. Zhang J, Pan T, Im H-J, Fu FH, Wang JH. Differential properties of human ACL and MCL stem cells may be responsible for their differential healing capacity. BMC Med. 2011 Dec;9(1):68.
54. Figueroa D, Espinosa M, Calvo R, Scheu M, Vaisman A, Gallegos M, et al. Anterior cruciate ligament regeneration using mesenchymal stem cells and collagen type I scaffold in a rabbit model. Knee Surg Sports Traumatol Arthrosc. 2014 May;22(5):1196–202.
55. Murray MM, Fleming BC. Use of a Bioactive Scaffold to Stimulate Anterior Cruciate Ligament Healing Also Minimizes Posttraumatic Osteoarthritis After Surgery. Am J Sports Med. 2013 Aug;41(8):1762–70..

How to Cite this article: Raman R, Mishra BN. Current trends in ACL repair: Primary repair, mechanical augmentation and biological supplementation. Journal of Clinical Orthopaedics July-Dec 2020;5(2):36-40.

 (Abstract    Full Text HTML)   (Download PDF)

Pediatric ACL in Sports, Prognosis, Decision Making and Outcomes of Management

Vol 3 | Issue 2 |  July-Dec 2018 | Page 16-21 | Reha N. Tandoğan, Metin Polat.

Authors: Reha N. Tandoğan[1], Metin Polat [2].

[1] ankaya Orthopedics, Ankara, Turkey,
[2] Orthopedic Surgeon, Cankaya Orthopedics, Ankara, Turkey

Address of Correspondence
Dr. Reha N. Tandogan,
Cinnahcaddesi 51/4 Cankaya Ankara, Turkey


Anterior cruciate ligament (ACL) injuries in pediatric & adolescent patients may occur as tibial eminence fractures, mid-substance ligament injuries and peel-off injuries of the femoral insertion site. ACL injuries in adolescents nearing skeletal maturity may be treated as adults without risk of deformity or leg length discrepancy. Treatment of ACL injuries children with wide open physes and substantial remaining growth are controversial. Disappointing functional results and an increased prevalence of secondary meniscal and cartilage damage with conservative management have led to an increased utilization of surgical treatment in these children. ACL reconstruction with soft tissue grafts and physeal sparing techniques are considered the gold standard of surgical management. Primary repair combined with healing enhancement techniques for femoral peel-off injuries with minimal damage to the body of the ACL can be used in select cases. The rates of growth disturbance after ACL surgery remain low with modern techniques and are usually clinically insignificant. However, a higher rate of failure and need for revision has been reported in pediatric & adolescent ACL injuries compared to adults. The risk of failure increases in patients with allografts and who return to high risk impact sports.
Keywords: Paediatric ACL tEAR, Physeal sparing techniques, repair


1. McConkey MO, Bonasia DE, Amendola A. Pediatric anterior cruciate ligament reconstruction. Curr Rev Musculoskelet Med. 2011 Jun;4(2):37-44.
2. Werner BC, Yang S, Looney AM, Gwathmey FW Jr. Trends in pediatric and adolescent anterior cruciate ligament ınjury and reconstruction. J PediatrOrthop. 2016 Jul-Aug;36(5):447-52.
3. Parkkari J, Pasanen K, Mattila VM, Kannus P, Rimpelä A. The risk for a cruciateligamentinjury of theknee in adolescentsandyoungadults: a population-basedcohortstudy of 46 500 peoplewith a 9 yearfollow-up. Br J Sports Med. 2008 Jun;42(6):422-6.
4. Bonnard C, Chotel F. [Kneeligamentandmeniscalinjury in childrenandadolescents]. RevChirOrthopReparatriceApparMot. 2007 Oct;93(6 Suppl):95-139.
5. Stracciolini A, Stein CJ, Zurakowski D, Meehan WP 3rd, Myer GD, Micheli LJ. Anterior cruciate ligament injuries in pediatric athletes presenting to sports medicine clinic: a comparison of males and females through growth and development.Sports Health. 2015 Mar;7(2):130-6.
6. Shaw KA, Dunoski B, Mardis N, Pacicca D. Knee morphometric risk factors for acute anterior cruciate ligament injury in skeletally immature patients. J Child Orthop. 2015 Apr;9(2):161-8.
7. Dare DM, Fabricant PD, McCarthy MM, Rebolledo BJ, Green DW, Cordasco FA, Jones KJ. Increased lateral tibial slope is a risk factor for pediatric anterior cruciate ligament injury: an MRI-based case-control study of 152 patients. Am J Sports Med. 2015 Jul;43(7):1632-9.
8. Wild CY, Steele JR, Munro BJ. Why do girls sustain more anterior cruciate ligament injuries than boys?: a review of the changes in estrogen and musculoskeletal structure and function during puberty. Sports Med. 2012 Sep1;42(9):733-49.
9. Baxter MP. Assessment of normal pediatric knee ligament laxity using the genucom. J PediatrOrthop. 1988; 8(5):546-50.
10. Moksnes H, Engebretsen L, Risberg MA. Performance-based functional outcome for children 12 years or younger following anterior cruciate ligament injury: a two to nine-year follow-up study. Knee Surg Sports TraumatolArthrosc. 2008; 16(3):214-23.
11. Dumont GD, Hogue GD, Padalecki JR, Okoro N, Wilson PL. Meniscal and chondral injuries associated with pediatric anterior cruciate ligament tears: relationship of treatment time and patient-specific factors. Am J Sports Med. 2012;40(9):2128-33.
12. Samora WP 3rd, Palmer R, Klingele KE. Meniscal pathology associated with acute anterior cruciate ligament tears in patients with open physes. J PediatrOrthop. 2011; 31(3):272-6.
13. Newman JT, Carry PM, Terhune EB, Spruiell MD, Heare A, Mayo M, Vidal AF. Factors predictive of concomitant injuries among children and adolescents undergoing anterior cruciate ligament surgery. Am J Sports Med. 2015Feb;43(2):282-8.
14. Anderson AF, Anderson CN. Correlation of meniscal and articular cartilage injuries in children and adolescents with timing of anterior cruciate ligament reconstruction. Am J Sports Med. 2015 Feb;43(2):275-81.
15. Guenther ZD. Meniscal injury after adolescent anterior cruciate ligament injury: how long are patients at risk? ClinOrthopRelat Res. 2014;472(3):990-7.
16. Woods GW, O’Connor DP. Delayed anterior cruciate ligament reconstruction in adolescents with open physes. Am J Sports Med. 2004 Jan-Feb;32(1):201-10.
17. Ardern CL, Ekås GR, Grindem H, Moksnes H, et al. L. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. Br J Sports Med. 2018 Apr;52(7):422-438.
18. Moksnes H, Engebretsen L, Eitzen I, Risberg MA. Functional outcomes following a non-operative treatment algorithm for anterior cruciate ligament injuries in skeletally immature children 12 years and younger. A prospective cohort with 2 years follow-up. Br J Sports Med. 2013 May;47(8):488-94.
19. Moksnes H, Engebretsen L, Risberg MA. Prevalence and incidence of new meniscus and cartilage injuries after a nonoperative treatment algorithm for ACL tears in skeletally immature children: a prospective MRI study. Am J Sports Med. 2013 Aug;41(8):1771-9.
20. Vavken P, Murray MM. Treating anterior cruciate ligament tears in skeletally immature patients. Arthroscopy. 2011 May;27(5):704-16.
21. Ramski DE. Anterior Cruciate Ligament Tears in Children and Adolescents: A meta-analysis of nonoperative versus operative treatment. Am J Sports Med. 2014 Nov;42(11):2769-76
22. Kay J, Memon M, Shah A, Yen YM, Samuelsson K, Peterson D, Simunovic N, Flageole H, Ayeni OR. Earlier anterior cruciate ligament reconstruction is associated with a decreased risk of medial meniscal and articular cartilage damage in children and adolescents: a systematic review and meta-analysis. Knee Surg Sports TraumatolArthrosc. 2018 Jun 6. doi: 10.1007/s00167-018-5012-5.
23. Kay J, Memon M, Marx RG, Peterson D, Simunovic N, Ayeni OR. Over 90 % of children and adolescents return to sport after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports TraumatolArthrosc. 2018 Apr;26(4):1019-1036
24. Seil R, Weitz FK, Pape D. Surgical-experimental principles of anterior cruciate ligament (ACL) reconstruction with open growth plates. J ExpOrthop. 2015 Dec;2(1):11. doi: 10.1186/s40634-015-0027-z.
25. Guzzanti V, Falciglia F, Stanitski CL. Preoperative evaluation and anterior cruciate ligament reconstruction technique for skeletally immature patients in Tanner stages 2 and 3. Am J Sports Med. 2003; 31(6):941-8.
26. Shea KG, Belzer J, Apel PJ, Nilsson K, Grimm NL, Pfeiffer RP. Volumetric injury of the physis during single-bundle anterior cruciate ligament reconstruction in children: a 3-dimensional study using magnetic resonance imaging. Arthroscopy. 2009; 25(12):1415-22.
27. Nawabi DH, Jones KJ, Lurie B, Potter HG, Green DW, Cordasco FA. All-inside, physeal-sparing anterior cruciate ligament reconstruction does not significantly compromise the physis in skeletally immature athletes: a postoperative physeal magnetic resonance imaging analysis. Am J Sports Med. 2014 Dec;42(12):2933-40.
28. Domzalski M, Karauda A, Grzegorzewski A, Lebiedzinski R, Zabierek S, Synder M. Anterior cruciate ligament reconstruction using the transphyseal technique in prepubescent athletes: Midterm, prospective evaluation of results. Arthroscopy. 2016 Mar 8. pii: S0749-8063(15)01002-6.
29. Calvo R, Figueroa D, Gili F, Vaisman A, Mocoçain P, Espinosa M, León A, Arellano S. Transphyseal anterior cruciate ligament reconstruction in patients with open physes: 10-year follow-up study. Am J Sports Med. 2015 Feb;43(2):289-94.
30. Redler LH, Brafman RT, Trentacosta N, Ahmad CS. Anterior cruciate ligament reconstruction in skeletally immature patients with transphyseal tunnels. Arthroscopy. 2012 Nov;28(11):1710-7.
31. Larson CM, Heikes CS, Ellingson CI, Wulf CA, Giveans MR, Stone RM, Bedi A. Allograft and autograft transphyseal anterior cruciate ligament reconstruction in skeletally immature patients: outcomes and complications. Arthroscopy. 2016May;32(5):860-7.
32. Astur DC, Arliani GG, Debieux P, Kaleka CC, Amaro JT, Cohen M. Intraarticular hamstring graft diameter decreases with continuing knee growth after ACL reconstruction with open physes. Knee Surg Sports TraumatolArthrosc. 2016 Mar;24(3):792-5.
33. Pennock AT, Chambers HG, Turk RD, Parvanta KM, Dennis MM, Edmonds EW. Use of a Modified All-Epiphyseal Technique for Anterior Cruciate Ligament Reconstruction in the Skeletally Immature Patient. Orthop J Sports Med. 2018 Jul 2;6(7):2325967118781769.
34. Frosch KH, Stengel D, Brodhun T, Stietencron I, Holsten D, Jung C, ReisterD,Voigt C, Niemeyer P, Maier M, Hertel P, Jagodzinski M, Lill H. Outcomes and risks of operative treatment of rupture of the anterior cruciate ligament in children and adolescents. Arthroscopy. 2010; 26(11):1539-50.
35. Collins MJ, Arns TA, Leroux T, Black A, Mascarenhas R, Bach BR Jr, Forsythe B.Growth abnormalities following anterior cruciate ligament reconstruction in the skeletally immature patient: a systematic review. Arthroscopy. 2016 May 7. pii:S0749-8063(16)00244-9.
36. Pierce TP. Pediatric Anterior Cruciate Ligament Reconstruction: A Systematic Review of Transphyseal Versus Physeal-Sparing Techniques. Am J Sports Med. 2016 Apr 4. pii: 0363546516638079.
37. Shifflett GD, Green DW, Widmann RF, Marx RG. Growth arrest following acl reconstruction with hamstring autograft in skeletally immature patients: a review of 4 cases. J PediatrOrthop. 2016 Jun;36(4):355-61.
38. Zimmerman LJ, Jauregui JJ, Riis JF, Tuten HR. Symmetric limb overgrowth following anterior cruciate ligament reconstruction in a skeletally immature patient. J PediatrOrthop B. 2015 Nov;24(6):530-4.

How to Cite this article: Tandoğan R N, Polat M. Pediatric ACL in sports, prognosis, decision making and outcomes of management. Journal of Clinical Orthopaedics July-Dec 2018;3(2):16-21.

(Abstract    Full Text HTML)      (Download PDF)