Reconstructive surgery to make the knee stable and prevent further injury is mainstream, but reconstruction while the bones are still growing has additional rules applied.

This image shows a knee side on, with the growth plates highlighted with white arrows.  Bones increase their length in childhood from these growth plates. The rules we apply to ACL reconstruction are that the growth plate should be crossed both perpendicularly, and as far away from the edge of the growth plate as possible.  The growth plate should only be crossed by soft tissue.

The fixation is slightly modified, the yellow line shows where the graft goes inside the femur up to the point that there is an “Endobutton” – which secures the graft to the outside of the femur.  In girls older than 12 and boys older than 14, the surgery should present little risk to the growth plates, but “bone age” might differ from actual age by two years.  Additional xrays of the hand or pelvis may be required to determine ‘’bone age’’.

The technique might differ even more if the patient is even younger, using a “physeal sparing” approach.

David Mitchell