Revision pediatric anterior cruciate ligament reconstruction after failure of iliotibial band technique treated with all-epiphyseal technique in a prepubescent with Ehlers–Danlos syndrome: a case report

Erdman, Mary Kate; Warnick, Drew E.

doi:10.1097/bpb.0000000000000298

Cited by 6 publications

(7 citation statements)

References 47 publications

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“…The only other report of an ACL reconstruction for ACL agenesis in an EDS patient is the one by Erdman and Warnick who described the initial failure of a non-anatomic physeal-sparing iliotibial (IT) band autograft, which was then followed by an all-epiphyseal revision ACL reconstruction with a posterior tibialis allograft [ 10 ]. This report, together with ours, is the only evidence of ACL reconstructions in a pediatric EDS patient with open growth plates.…”

Section: Discussionmentioning

confidence: 99%

“…This choice was also supported by the satisfactory experiences on EDS patients reported by Choi et al [ 9 ] who used an Achilles tendon allograft. Furthermore, Erdman and Warnick [ 10 ], who had a failure of the previously used IT band autograft, then successively performed a revision reconstruction using a posterior tibialis allograft. On the other hand, Williams et al [ 8 ] used a hamstring autograft but reinforced it with a LARS synthetic ligament.…”

Section: Discussionmentioning

confidence: 99%

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Anterior Cruciate Ligament Agenesia in a Patient with Ehlers-Danlos Syndrome and Open Physes

Conte¹,

Adravanti²,

Gaggia³

et al. 2022

JOCR

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Introduction: The agenesis of the anterior cruciate ligament (ACL) is a rare condition infrequently diagnosed as an isolated malformation. Still, it is linked to systemic disorders such as Ehlers-Danlos syndrome (EDS), an inheritable connective tissue disorder characterized by joint hyperlaxity and increased risk of dislocations and subluxations. The literature on ACL reconstruction in EDS patients is minimal, and ours is the second case report describing the surgical management of an ACL agenesis in a patient with this pathology. Case Presentation:The present case report describes the surgical management of an 11-year-old patient affected by EDS. The particularity of this case is that the young patient presented with complete agenesis of the ACL in the right knee resulting in severe joint instability needing surgical reconstruction. This case represented a challenge for the orthopedic surgeon due to the need to improve joint stability without compromising the bone growth of a young patient with open physes while also dealing with tissues that have reduced mechanical properties due to the patient’s disease. The patient was therefore treated with an Achilles tendon allograft through a modified version of the typical ACL reconstructive surgery that excluded the classical tunnel drilling in the tibia and femur. Conclusion:At a 2-year follow-up, this technique proved to be an effective treatment for ACL agenesis in an EDS patient. It could provide a reference for surgeons facing similar cases. The proposed surgical technique, completely extra-epiphyseal, could also be applied to healthy young patients with open physes to avoid future growth disturbances. Keywords:Anterior cruciate ligament, anterior cruciate ligament agenesis, Ehlers-Danlos, pediatric anterior cruciate ligament reconstruction, anterior cruciate ligament reconstruction, anterior cruciate ligament agenesis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anterior Cruciate Ligament Agenesia in a Patient with Ehlers-Danlos Syndrome and Open Physes

Conte¹,

Adravanti²,

Gaggia³

et al. 2022

JOCR

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“…No evidence exists regarding the graft choice and outcomes for cruciate ligament (anterior or posterior) reconstructions in patients with hEDS or other connective tissue disorders. 38) Simonian and Luck 39) reported a case of a 21-year-old female who successfully underwent synthetic posterior cruciate ligament reconstruction and who had also received a lower extremity prosthesis following a below-the-knee amputation related to EDS. 39) Other case reports have reported the outcomes of ACL reconstruction in patients with this condition.…”

Section: Knee Abnormalities In Patients With Heds/jhsmentioning

confidence: 99%

“…At 28 months after the revision ACL reconstruction procedure in 1 knee, the patient had a stable Lachman test and excellent functional outcome based on the Pediatric International Knee Documentation Committee score and Lysholm knee questionnaire. 38) . No studies have explored the outcomes of the above procedures in larger groups of patients with EDS or other connective tissue disorders, and therefore, future investigation in this field is warranted.…”

Section: Knee Abnormalities In Patients With Heds/jhsmentioning

confidence: 99%

Surgical Management of Shoulder and Knee Instability in Patients with Ehlers-Danlos Syndrome: Joint Hypermobility Syndrome

et al. 2020

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Ehlers-Danlos Syndrome (EDS) is a hereditary disorder of the connective tissue, which has been classified into numerous subtypes over the years. EDS is generally characterized by hyperextensible skin, hypermobile joints, and tissue fragility. According to the 2017 International Classification of EDS, 13 subtypes of EDS have been recognized. The majority of genes involved in EDS are either collagen-encoding genes or genes encoding collagen-modifying enzymes. Orthopedic surgeons most commonly encounter patients with the hypermobile type EDS (hEDS), who present with signs and symptoms of hypermobility and/or instability in one or more joints. Patients with joint hypermobility syndrome (JHS) might also present with similar symptomatology. This article will focus on the surgical management of patients with knee or shoulder abnormalities related to hEDS/JHS.

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“…2). This technique may be used as a primary reconstruction, or in skeletally immature patients who require revision reconstruction 106 . Grafts prepared with subsequent pretensioning and circumferential compression may minimize bone removal in small knees 107 .…”

Section: Physeal Sparing: All-epiphyseal Techniquementioning

confidence: 99%

Management of ACL Injuries in Children and Adolescents

Fabricant

Kocher

2017

The Journal of Bone and Joint Surgery

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ä Children and adolescent athletes constitute the largest demographic of patients who sustain anterior cruciate ligament (ACL) tears, and the frequency is increasing. ä In ACL-deficient children and adolescents, continued symptoms of instability can result in progressive meniscal and cartilage damage as well as arthritic changes. ä Growth disturbance can occur after ACL surgery in children, and includes tibial recurvatum due to tibial tubercle apophyseal arrest as well as limb-length discrepancy and/or angular deformity due to physeal arrest or overgrowth. ä Several "physeal sparing" and "physeal respecting" ACL reconstruction techniques have been developed for use in skeletally immature patients to minimize the risk of growth disturbance, with favorable clinical outcomes. ä ACL injury prevention strategies include neuromuscular conditioning and may be performed to prevent both initial ACL injury as well as reinjury and injury of the contralateral ACL after reconstruction. Disclosure: No internal or external funding was provided for this project. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/B603).

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Revision pediatric anterior cruciate ligament reconstruction after failure of iliotibial band technique treated with all-epiphyseal technique in a prepubescent with Ehlers–Danlos syndrome: a case report

Cited by 6 publications

References 47 publications

Anterior Cruciate Ligament Agenesia in a Patient with Ehlers-Danlos Syndrome and Open Physes

Anterior Cruciate Ligament Agenesia in a Patient with Ehlers-Danlos Syndrome and Open Physes

Surgical Management of Shoulder and Knee Instability in Patients with Ehlers-Danlos Syndrome: Joint Hypermobility Syndrome

Management of ACL Injuries in Children and Adolescents

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