Table 1 Surgical-experimental principles of pediatric ACL-reconstruction

1.

Growth plate cartilage does generally not regenerate after a drill injury.

2.

Leaving a transphyseal drill hole empty results in the formation of a bone bridge.

3.

Small bone bridges may resolve spontaneously.

4.

The formation of a bone bridge may be prevented by the transphyseal placement of a tendon graft.

5.

Permanent transphyseal hardware placement can result in a growth abnormality.

6.

A central growth plate lesion may result in a symmetric shortening whereas a peripheral growth plate lesion may result in an axial deformity.

7.

The critical size for a growth abnormality due to a central growth plate lesion is 7-9% of the size of the growth plate.

8.

The critical size for a growth abnormality due to a peripheral growth plate lesion is 3-5% of the circumference of the growth plate.

9.

The size of the growth plate injury increases with drilling obliquity.

10.

The risk of a growth deformity is inversely proportional to the remaining growth potential.

11.

The force of the growth plate is associated with body weight.

12.

An excessive graft tension may lead to a tenoepiphysiodesis.

13.

During femoral tunnel drilling, iatrogenic injury to perichondral structures should be avoided.

14.

Epiphyseal and transphyseal ACL reconstructions may induce rotational deformities at the distal femur.

15.

Graft incorporation is faster in immature specimen as compared to adults.