PATELLAR TENDON GRAFT RECONSTRUCTION FOR MIDSUBSTANCE ANTERIOR CRUCIATE LIGAMENT RUPTURE IN JUNIOR-HIGH-SCHOOL ATHLETES - AN ALGORITHM FOR MANAGEMENT

Between 1976 and 1988 we treated 75 junior high athletes who had midsu bstance ruptures of the anterior cruciate ligament and open physes. Th irty-eight children were initially treated conservatively and later ha d an intraarticular patellar tendon graft reconstruction, 2 patients u nderwent extraarticular reconstruction and then later had a patellar t endon graft intraarticular reconstruction, and 20 children had a patel lar tendon graft reconstruction initially. In all 60 patients the tibi al and femoral tunnels were drilled through the open physes. Minimum f ollowup was 2 years (mean, 4.2). Fifty-five of the 60 children were ab le to return to their original sports; 5 were active in less strenuous sports. No incidence of abnormal growth related to the intraarticular reconstructive surgery was recorded. Three children tore their anteri or cruciate ligament grafts more than 2 years after surgery. Our recor ds showed that conservative treatment of the active junior high athlet e with an anterior cruciate ligament rupture failed in each case becau se of recurrent giving way or meniscal tears. Definitive treatment wit h an intraarticular autogenous patellar tendon graft reconstruction yi elded good to excellent results and eliminated subsequent instability episodes and meniscal tears in our study group.