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1. Chronicity
2. Mechanism of injury ( Contact Vs
Noncontac)
3. Nearly half of all ACL injuries are
associated with a hemarthrosis
between 6 and 12 hours after
injuries
Physical Examination
O Surgical Management
Surgycal management is guided by :
- Patients skeletal
- Physiologic maturity
- Chronologic maturity
nner Stages of Physiologic Maturity
Stage 1 Stage 2 Stage 3 Stage 4 Stage 5
Boys
Growth 5-6cm/y 5-6cm/y 7-8cm/y 10 cm/y None
Testes, penis Testes : <4ml Testes : 4ml or Testes : 12 mL Testes : 4.1- Testes fully
or <2.5cm 2.5-3.5cm; or 3.6 cm; 4.5 cm; mature in
penis usually enlargement, increased size shape and
not yet lengthening of and breadth of size
enlarged penis penis
Pubic hair None Sparse. At Pubic hair Adult-like, but Fully mature in
base of penis over pubis; over a smaller type and
darker, area quantity,
coarser, and extending to
more curied the thighs
Girl
Growth 5-6 cm/y 7-8cm / y 8cm/y 7cm / y None
Breasts No Buds Elevation and Areolae and None Mature
development aerolar Papillae form
enlargement secondary
mound
Pubic hair None Sparse, on On mond Adult-like, but Fully mature in
labia; slightly pubis; darker, over a smaller type and
pigmented coarser, and area quantity,
more curled extending to
the thighs
Algorithm for anterior cruciate ligament reconstruction in the
skeletally immature patient
ACL tear in skeletally
immature patient
Partial
( <50% fibers Complete
torn)