Vordere Kreuzbandruptur bei offenen Wachstumsfugen

The treatment of anterior cruciate ligament injuries in skeletally immature patients with open growth plates is in an state of flux. In contrast to earlier, when conservative treatment was advised, it is now almost universally agreed that surgical repair is best, since the high level of physical activity in most children and adolescents can lead to secondary damage to menisci and cartilage. When bony avulsion is also present fixation with wires or screws generally gives good or excellent results with no functional loss, while sutures almost always fail to retain the ruptured ligamentous fibers. Reasonable short- and mid-term results have been observed following transepiphyseal ligament replacement with hamstring tendon strands anchored extracortically. When patellar ligament grafts are used, femoral fixation must be carried out cranial to and through the condyle and in an over-the-top fashion, so as to prevent early growth plate closure. Concomitant injuries, and especially meniscal tears, frequently lead to a poor outcome if left untreated, and adequate operative management is therefore essential. In the postoperative period sustained physiotherapy is indispensable to ensure a good result of reconstructive surgery and hasten rehabilitation, and also to optimize the functional outcome.