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Anterior cruciate ligament (ACL) reconstruction in skeletalIy immature patients presents unique technical challenges as their physes are still open. Traditional, adult style reconstruction methods that call for tunnels to be drilled across both the proximal tibial and the distal femoral growth plates have the potential to cause a growth arrest in a skeletally immature patient. In the over-the-top method, the risk of growth arrest is minimized by avoiding the tibial tubercle and placement of the graft through the femoral notch and fixing it proximal to the femoral physis (Figure 1). This article presents a case of a staple migrating proximally following femoral fixation of an over-thetop graft in a skeletally immature patient.
CASE REPORT
In February of 1999, a 15-year-old boy presented to the orthopedic clinic. Examination demonstrated a positive Lachman and anterior draw test as well as a click with a McMurry test but no pain. A magnetic resonance image scan of the left knee showed the ACL to be completely torn through the distal midportion as well as a minor tear of the posterior horn of the lateral meniscus. The posterior cruciate ligament (PCL) appeared intact and no medial meniscal injury was seen.
Medical history included a left knee injury at age 10 years. In October of 1998, He twisted his left knee while playing football. He was hit in the shoulder while his left foot was planted. He...