Complications in Pediatric Anterior Cruciate Ligament Surgery: The Iliotibial Band Technique

Introduction

The incidence of anterior cruciate ligament (ACL) injuries in skeletally immature patients increases continuously. This increase is partially because of the developed awareness of the condition and seeking of medical treatment, but also owing to an actual increase of ACL injuries in children, because of greater year-round participation in organized sports at a younger age and early sports specialization. ^,

As a consequence, the number of ACL tears in children that require surgical management has increased rapidly, with an average of 58 per 100,000 skeletally immature patients per year being treated for an ACL injury. ^,

Despite this increase, controversy still surrounds important aspects of the management of pediatric ACL injuries, such as nonoperative versus operative treatment, the surgical techniques, and the complications after ACL reconstruction (ACLR). Regarding conservative management, recent research offers a significant amount of evidence suggesting a limited role because of the high risk of subsequent cartilage and meniscus injury. ^, The outcomes of surgical management appear to be promising, especially in a population with high activity levels that corresponds to increased risk of ACL graft tear. Furthermore, the question of potential growth disturbance after ACLR in a patient with open growth plates is critical, but the answer has to be associated with the surgical technique involved.

This chapter will discuss physeal-sparing ACLR with the use of iliotibial (IT) band autograft in skeletally immature patients, focusing on the preoperative, intraoperative, and postoperative complications associated with this technique.