Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients With Transphyseal Tunnels

Transphyseal ACL Reconstruction in Skeletally Immature Patients: Does Independent Femoral Tunnel Drilling Place the Physis at Greater Risk Compared to Transtibial Drilling?

“…Most studies demonstrating the safety and efficacy of transphyseal ACL reconstruction have utilized femoral tunnels drilled across the distal femoral physis via a transtibial drilling technique. 3,4,8,12,17,18,20,21,33 Recent literature has suggested that independent femoral tunnel drilling may allow for more anatomic placement of the graft within the native ACL footprint and thus more accurately The Orthopaedic Journal of Sports Medicine Transphyseal ACL Femoral Tunnel Drilling 3 restore normal knee biomechanics compared with transtibial drilling techniques. Because of this, many surgeons have adopted independent femoral tunnel drilling.…”

“…6,9,28 Transphyseal ACL reconstruction involves drilling bone tunnels across an open physis and fixing a soft tissue graft away from the physis. Although multiple case series have noted transphyseal ACL reconstruction to be safe and effective, 3,4,8,12,20,21,33 some animal studies have described limb shortening, deformity, and growth arrest after transphyseal tunnel placement, especially in relatively large tunnels and tunnels placed eccentrically through the physis. 7,10,11,26 Clinically, some authors have also noted cases of growth arrest after transphyseal ACL reconstruction.…”

“…19,22,35 Most published series that note low rates of growth disturbance with transphyseal ACL reconstruction utilize a transtibial drilling technique and have vertically oriented femoral tunnels. 3,4,8,12,17,20,21,33 Recent literature has suggested that oblique, anatomically placed femoral tunnels more accurately restore normal knee biomechanics, particularly with simulated Lachman and pivot-shift testing. 1,15,28,37,38 Many surgeons are therefore choosing independent femoral tunnel drilling techniques to achieve a more anatomic graft placement and thus are creating more obliquely oriented tunnels.…”

Pediatric ACL injuries: evaluation and management

“…Transphyseal ACL reconstruction has been found to be safe by a number of authors [63][64][65][66][67]. In a multi-center study, Gebhard et al found no difference between hamstring grafts, bone-patellar tendon-bone, quadriceps tendon, and fascia lata grafts in terms of outcomes, failure, or growth disturbance [64].…”

Anterior cruciate ligament reconstruction in skeletally immature patients

“…Seven other retrospective case series were identified over the last few years with cohort volumes ranging from 15 to 30. The mean Lysholm and IKDC scores for all of these series were >90, and there was only a single case of a growth abnormality which consisted of a valgus deformity [47][48][49][50][51][52][53].…”