Who should consider anterior cruciate ligament deficiency surgery?
Children and adolescents with pathologic laxity (positive pivot shift or greater than 10-12 mm of anterior translation on Lachman’s test) would benefit most from reconstruction of their anterior cruciate ligament, so as to protect their knee from meniscal or chondral injury. Those with ACL deficiency without pathologic laxity would probably do best to pursue an aggressive non-operative ACL rehabilitation program. They should participate in sports in a hinged knee brace designed to prevent against hyperflexion (bending beyond the normal amount of knee bending), hyperextension (straightening past the normal amount of knee straightening), varus and valgus deformity (bow-legged or knock-kneed deformities), and anterior translation of the tibia on the femur (increased forward slipping of the tibia at the knee) until such time as they approach within one-two years of skeletal maturity, or they are unsatisfied with this form of treatment. For those who fail these tests for non-operative manag
