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Growth Stimulation Following an All-Epiphyseal Anterior Cruciate Ligament Reconstruction in a ChildA Case Report
Senthil T. Nathan, MD1; Marios G. Lykissas, MD, PhD1; Eric J. Wall, MD1
1 Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 2017, Cincinnati, OH 45229-3039. E-mail address for E.J. Wall: eric.wall@cchmc.org
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Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Feb 13;3(1):e14 1-6. doi: 10.2106/JBJS.CC.L.00179
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Over the past decade, there has been a substantial increase in the number of reported intrasubstance tears of the anterior cruciate ligament (ACL) in children younger than twelve years of age or in prepubescent children1-6. Multiple studies have emphasized the need for early ACL reconstruction in skeletally immature patients to prevent the development of meniscal tears and early knee arthrosis7-10. The native ACL in children always courses from the distal femoral epiphysis to the proximal tibial epiphysis. If the usual ACL reconstruction used in adults is performed on a child or adolescent, this anatomy becomes problematic because tunnels are drilled through the growth plates into the distal part of the femur and the proximal tibial metaphyses. In children with wide-open growth plates, a solidly fixed and tensioned graft, placed as in adults, may potentially cause a “tether effect” that can retard growth at these growth plates11,12. In order to avoid tether or bone-bar formation, multiple partial or complete physeal-sparing techniques to reconstruct the ACL in this age group have been proposed1,6,13-16.
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