ANTERIOR CRUCIATE LIGAMENT INJURIES IN PATIENTS WITH OPEN PHYSES

From July 1988 to August 1989, six children with open physes and injur ies to the anterior cruciate ligament were treated operatively. All in juries involved twisting episodes during sports activities. Ail six pa tients had meniscal abnormalities, and, additionally, one patient sust ained a Grade III medial ligament tear and had a lateral patellar disl ocation. Operative reconstruction used hamstring tendons and placed a groove over the front of the tibia and a groove over the top of the fe mur without violation of the growth plates. The anterior cruciate liga ment was primarily repaired (three patients) at the time of reconstruc tion, if possible. At 3 months, one patient underwent arthroscopic res ection of adhesions for arthrofibrosis. There were no other complicati ons. Five patients were evaluated with clinical examination, radiograp hs, magnetic resonance imaging, and functional testing at an average f ollowup of 33.2 months (range, 25 to 38). Four of the five had returne d to their preinjury level of sports participation. Manual maximum KT- 1000 arthrometer side-to-side differences averaged 3.6 +/- 1.9 mm. The average Lysholm knee score was 95.2 +/- 2.5; the average Hospital for Special Surgery knee score was 96.6 +/- 2.3. There were no growth pla te injuries. Despite the overall clinical stability, magnetic resonanc e image scans of the five patients consistently demonstrated areas of increased signal in the anterior cruciate ligament grafts.