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Paediatric ACL repair reinforced with temporary internal bracing

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Instability following non-operative treatment of anterior cruciate ligament (ACL) rupture in young children frequently results in secondary chondral and/or meniscal injuries. Therefore, many contemporary surgeons advocate ACL reconstruction in these patients, despite the challenges posed by peri-articular physes and the high early failure rate. We report a novel management approach, comprising direct ACL repair reinforced by a temporary internal brace in three children.

Methods

Two patients (aged 5 and 6 years) with complete proximal ACL ruptures and a third (aged seven) with an associated tibial spine avulsion underwent direct surgical repair, supplemented with an internal brace that was removed after 3 months.

Results

Second-look arthroscopy, examination and imaging at 3 months confirmed knee stability and complete ACL healing in all cases. Normal activities were resumed at 4 months, and excellent objective measures of function, without limb growth disturbance, were noted beyond 2 years.

Conclusion

ACL repair in young children using this technique negates the requirement and potential morbidity of graft harvest and demonstrates the potential for excellent outcome as an attractive alternative to ACL reconstruction, where an adequate ACL remnant permits direct repair.

Level of evidence

IV.

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Acknowledgments

We acknowledge Professor Gordon MacKay who provided the initial description of the internal brace.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, North Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, UK

    James O. Smith, Sam K. Yasen, Harry C. Palmer, Breck R. Lord, Edward M. Britton & Adrian J. Wilson

  2. Department of Sport and Exercise, Sport and Exercise Research Centre, University of Winchester, Winchester, SO22 4NR, UK

    James O. Smith, Sam K. Yasen, Harry C. Palmer, Breck R. Lord, Edward M. Britton & Adrian J. Wilson

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  1. James O. Smith
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Corresponding author

Correspondence to Adrian J. Wilson.

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Conflict of interest

AJW is a consultant for Arthrex.

Appendix

Appendix

Videos demonstrating the operative procedure of the first two cases can be found at:

https://www.vumedi.com/video/acl-repair-using-the-internal-brace-in-a-5-year-old/.

http://academy.esska.org/esska/2014/video.library.2014/113073/adrian.wilson.acl.repair.in.a.6.year.old.using.the.internal.brace.technique.html?f=p19l4405m10.

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Smith, J.O., Yasen, S.K., Palmer, H.C. et al. Paediatric ACL repair reinforced with temporary internal bracing. Knee Surg Sports Traumatol Arthrosc 24, 1845–1851 (2016). https://doi.org/10.1007/s00167-016-4150-x

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  • DOI: https://doi.org/10.1007/s00167-016-4150-x

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