Vicente R. Gomez, MD, FPOA, FPCS. FPOSNA

Philippines

Lecture Topic: ACL Reconstruction in Skeleletally IImature Patient

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Graduated UP College of Medicine 1981 and completed Residency in Orthopedics at the National Orthopedic Hospital in 1987. Completed Fellowship in Pediatric Orthopedics at Childrens Hospital at Stanford, Palo Alto CA 1988-89. Further studies in Hand and Peripheral Nerve Surgery, Ospedale Legnano in Milan, Italy with Dr Luigi Restelli and at Clinique Longeraise with Dr. Algi Narakas; Foot and Ankle Surgery, Oakland Hospital with Dr. Roger Mann; Ilizarov Technique with Drs. Dror Paley and Deborah Bell at Hennepin County, Minnesota; Selective Spasticity Surgery for Cerebral Palsy at Kyushu University with Dr. Takashi Matsuo


Member of Pediatric Orthopedic Society of North America since 1990 and recipient of the Howard Steel award for best Clinical Paper at POSNA 1992. Also a member of Phil Orthopedic Association, Philippine College of Surgeons and PMA. Career Executive Service Officer since 2016.


Presently CEO of the Philippine Orthopedic Institute and Active Staff at Makati Medical Center, Cardinal Santos Medical Center, Providence Hospital, and Philippine Childrens Medical Center (PCMC). Formerly Director of Professional Services and Director of Hospital Services at PCMC. Former Director of Philippine Cerebral Palsy Institute (1992-2007). Board of Trustees of RTR Memorial Hospital, Tacloban, Leyte. Presently head of Sports Medicine Team De La Salle University, College of St Benilde and La Salle Green Hills and the Moran Foundation Futsal program.  Also a  columnist in the Inquirer Golf magazine. Chairman of the Board of Aristocrat Group of Companies. Director of "Batand Matuwid" Charity fund for Indigent Pediatric Orthopedic patients at both POI and PCMC.


Lecture: ACL Reconstruction in Skeleletally IImature Patient  

Abstract: 

Anterior Cruciate Ligament Injuries are now being seen in a younger population due to children getting more actively involved in sports and extreme activities early on. In the past, when children sustain an ACL injury, surgery was not an option. The standard course of management was bracing and restriction of activity. However, non-operative treatment resulted in a large percentage of meniscal and chondral injuries. With newer understanding of the role of the ACL in preventing further injury and the behavior of the growing knee after undergoing reconstructive surgery, Sports Medicine specialists are now performing ACL reconstructions as soon as six weeks after injury.


Surgical options include: (1) Extra-articular (over the top) reconstruction using hamstring grafts; (2) Transphyseal tunneling using the standard ACL tunnels going through the tibial and femoral physes; (3) physeal sparing surgery utilizing an all in Epiphyses tunnels or (3)  Hybrid which is usually a transphyseal tibial tunnel and an all Epiphysis Femoral tunnel and the most recent method is the (4) ACL repair with an Internal Brace.  Physeal Sparing surgery is best safely done with the use of a fluoroscope. The graft size is optimally between 7-9 mm, 8mm being most common. If tunnels are made through the phsyes, they should not be more than 10 mm in diameter taking into consideration if the tunnels are angled. Graft incorporation must be allowed before return to active sports to prevent re-rupture. The most commonly seen complications are: Graft rupture, Technical Errors in graft positioning and preparation, growth and angular deformities. Growth deformities overall are not statistically significant. It is recommended that surgeons adept in performing ACL reconstructions in Adults should consider ACL reconstructions in patients with Open growth plates within six weeks after injury without fear of injuring the growth plate if this is done  using the recommendations given.