All-epiphyseal anterior cruciate ligament reconstruction produces good functional outcomes and low complication rates in pediatric patients: a systematic review

Abstract

Purpose To assess the literature on indications, outcomes, and complications in pediatric patients undergoing all-epiphyseal (AE) anterior cruciate ligament reconstruction (ACLR). Methods PubMed, Medline, and Embase were searched for literature evaluating AE ACLR in pediatric patients. All included studies were assessed for quality using the Methodological Index for Non-Randomized Studies (MINORS). Descriptive statistics are presented where applicable. Results Overall, 17 studies comprising 545 patients, with a mean age of 12.0 ± 1.2 (range 8-19) met the inclusion criteria. The graft choices in this systematic review included hamstring tendon autografts (75.4%, n = 403), quadriceps tendon autograft (6.2%, n = 33), Achilles tendon allograft (3.6%, n = 19) and posterior tibialis tendon allograft in one patient (0.2%, n = 1). Time of return-to-sport ranged from 8 to 22 months. Postoperative subjective IKDC scores were above 90 points. The rate of return-to-sport after AE ACLR was 93.2% (n = 219/235) and 77.9% (n = 142/183) of patients returned to sport at pre-injury level. The overall complication rate was 9.8% (n = 53/545) with the most common complication being ACL re-rupture (5.0%; n = 27/545). Only 1.5% (n = 8/545) of patients demonstrated growth disturbances. Conclusion Overall, the AE ACLR technique can achieve good postoperative functional outcomes while notably minimizing the incidence of primary issue of physeal disruption and potential associated leg-length discrepancies. AE ACLR should be considered in pediatric patients with at least 2 years of skeletal growth remaining based on radiographic bone age to minimize the impact of growth-related complications. Level of evidence IV (Systematic Review of Level III and IV evidence).

Quadriceps Tendon Autograft Versus Bone–Patellar Tendon–Bone and Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

“…10,57,77,93 Moreover, the MINORS includes 12 items, one of which is whether the studies have an appropriate follow-up; therefore, the MINORS has also been extensively used in systematic reviews and meta-analyses to assess the quality of articles on ACL reconstruction with a different length of follow-up. 23,34,42,91,97 Second, the studies included were heterogeneous in terms of rehabilitation methods, ACL reconstruction techniques, and the type of QT grafts. These factors may potentially influence the outcomes of the patients.…”

All-Epiphyseal Double-Bundle Anterior Cruciate Ligament Reconstruction for Skeletally Immature Patients

“…8 Only 8 of 545 patients (1.5%) showed growth disturbances. Of course, there are potential risks to all-epiphyseal ACL reconstruction, such as graft rerupture, limb overgrowth, limblength discrepancies, arthrofibrosis, knee stiffness, soft-tissue infection, 8 and EndoButton migration within the joint. 6 Several meta-analyses have shown that DB reconstruction decreases the postoperative positive pivotshift ratio significantly more than single-bundle (SB) reconstruction.…”

“…6 Several authors have reported on all-epiphyseal ACL reconstruction techniques. 3,4,7,8 On the basis of a recent systematic review of 17 articles (N ¼ 545), all-epiphyseal ACL reconstruction was very safe and had excellent postoperative functional results. 8 Only 8 of 545 patients (1.5%) showed growth disturbances.…”

“…3,4,7,8 On the basis of a recent systematic review of 17 articles (N ¼ 545), all-epiphyseal ACL reconstruction was very safe and had excellent postoperative functional results. 8 Only 8 of 545 patients (1.5%) showed growth disturbances. Of course, there are potential risks to all-epiphyseal ACL reconstruction, such as graft rerupture, limb overgrowth, limblength discrepancies, arthrofibrosis, knee stiffness, soft-tissue infection, 8 and EndoButton migration within the joint.…”

Improved epiphyseal socket placement with intraoperative 3D fluoroscopy: a consecutive series of pediatric all-epiphyseal anterior cruciate ligament reconstruction

“…First popularized by Anderson [1, 2], this technique describes an ACLR with tunnels or sockets within the epiphysis that theoretically should not violate the physis [27]. Nevertheless, incidence of some physeal disturbances following all‐epiphyseal ACLR have been reported ranging from 52 to 67% and growth disturbances ranging from 0 to 15% [6, 12, 18, 19, 33, 35, 39, 40].…”