Anterior Cruciate Ligament Reconstruction in Patients with Open Physes: Early Outcomes

Abstract

Both nonoperative and operative treatments for anterior cruciate ligament (ACL) deficient knees in skeletally immature patients have reported potentially negative outcomes. This study describes primary ACL reconstruction patients with open physes and their concurrent injuries and evaluates whether these patients are at a higher early risk of revision and reoperation than closed physes patients. A retrospective analysis of prospectively collected data was performed. Patients were identified using an ACL Reconstruction Registry. Summary statistics comparing open and closed physes patients of similar ages in regard to patient characteristics and incidence of early revision and reoperation are provided. Adjusted Cox regression models assessed risk of early revision and reoperation for open physes patients. Of 1,867 patients identified, 232 (12.4%) patients had open physes and 1,635 (87.6%) patients had closed physes. Patients with open physes were younger, less likely to be women, and had less medial meniscal injuries than closed physes patients. No significant differences were observed in cartilage injury, overall menisci injury and repair, and early revision and reoperation rate. According to the our results, no significant differences in risk of early revision or early reoperation in open physes compared with closed physes patients when adjusting for age were observed, nor were there any reoperations for physeal closure.

Nonanatomic Anterior Cruciate Ligament Reconstruction With Double-Stranded Semitendinosus Grafts in Children With Open Physes

“…Csintalan et al 10 In children, we believe that there is less risk with the surgical treatment for ACL tears compared with the complications of a nonfavorable outcome resulting from nonoperative treatment. Nonoperative treatment may lead to chronic instability, meniscal tears, and cartilage degeneration 14,25 ; early surgical intervention provides better outcomes, particularly in preventing further meniscal injuries.…”

“…We observed 2 medial meniscal tears (16%) in our series. Csintalan et al 10 have reported that patients with ACL injuries with open physes are less likely to be women and had fewer medial meniscal injuries compared with patients with closed physes. Samora et al 32 have reported that lateral meniscal tears are more common than medial meniscal tears.…”

Pediatric anterior cruciate ligament reconstruction outcomes

“…Csintalan et al [28] performed a retrospective study of their registered cohort of primary ACLR in 232 skeletally immature patients (median age 15.1 years) and retrospectively compared these to 1635 patients with closed physis (mean age 16.6 years). Median follow-up time for the group was 498 days.…”

Assessment of Skeletal Maturity and Postoperative Growth Disturbance After Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review

“…References 1, 2, 4 -9, 11, 13, 14, 17-22, 24-29, 31, 33, 34, 38-50, 52-54, 56, 58-61, 63-67, 69-74, 76-78, 81-86, 88, 89, 91...…”