Anterior Cruciate Ligament Rupture in Skeletally Immature Patients

Figures

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  Figure 1. Coronal and sagittal T1-weighted MRIs showing the knee of a 6-year-old girl, marking the femoral insertion of the anterior cruciate ligament.

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  Figure 2. Sagittal T1-weighted MRI showing the knee of a 13-year-old boy, measuring of the maximum oblique intraepiphyseal depth.

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  Figure 3. Sagittal T1-weighted and STIR-weighted MRIs showing the knee of a 15-year-old boy, with a complete anterior cruciate ligament rupture and associated meniscal tear.

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  Figure 4. A schematic diagram showing the transphyseal reconstruction technique. AP and lateral postoperative radiographs showing the knee of a 14-year-old boy with a transphyseal anterior cruciate ligament reconstruction.

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  Figure 5. A schematic diagram showing the extraphyseal reconstruction technique. The iliotibial band graft is harvested free proximally and left attached to the Gerdy tubercle distally, then brought through the knee in the over-the-top position posteriorly, through the knee and under the intermeniscal ligament anteriorly.

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  Figure 6. A schematic diagram showing the all-epiphyseal anatomical reconstruction technique. AP and lateral postoperative radiographs showing the knee of a 12-year-old boy with an all-epiphyseal anterior cruciate ligament reconstruction.

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  Figure 7. A schematic diagram showing the hybrid reconstruction technique, with an all-epiphyseal femoral tunnel and transphyseal tibial tunnel. AP and lateral postoperative radiographs showing the knee of a 13-year-old boy with this technique, associated with an anterolateral ligament reconstruction fixed with a suture anchor.

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  Figure 8. Chart showing the therapeutic treatment algorithm preferred by the authors for the choice of the anterior cruciate ligament reconstruction technique in patients with immature skeleton.