Clinical Outcomes and Postoperative Complications After All-Epiphyseal Double-Bundle ACL Reconstruction for Skeletally Immature Patients

Abstract

Background: The treatment strategy for pediatric anterior cruciate ligament (ACL) tears, especially in patients with open physes, remains controversial. Purpose: To assess clinical outcomes and postoperative complications after all-epiphyseal double-bundle ACL (DB-ACL) reconstruction for patients with open physes. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 102 patients aged ≤15 years who underwent ACL reconstruction at a single institution and had a minimum of 2 years of follow-up. Of these patients, 18 had undergone all-epiphyseal DB-ACL reconstruction (mean age, 12.4 ± 1.2 year) and 84 had undergone conventional DB-ACL reconstruction (mean age, 14.1 ± 0.9 year). The outcomes of the all-epiphyseal group were compared with those of the conventional group. Objective clinical outcomes included KT-1000 arthrometer measurements of side-to-side difference in anterior tibial translation, Lachman test grade, and pivot-shift test grade. Radiographic angular deformity (defined as >3° of the side-to-side difference in femorotibial angle) and incidence of second ACL injury were also compared. Results: The postoperative side-to-side difference in laxity significantly improved from 6.1 ± 2.4 to 0.6 ± 0.9 mm in the all-epiphyseal group ( P = .001), and postoperative laxity was similar to that of the conventional group (0.4 ± 0.8 mm; P = .518). A Lachman grade 1 positive result was observed in 20% of the all-epiphyseal group and 3% of the conventional group ( P = .042), and a pivot-shift grade 1 positive result was observed in 22% of the all-epiphyseal group and 4% of the conventional group ( P = .074). A total of 4 patients (26.7%) in the all-epiphyseal group and 4 (6.1%) in the conventional group demonstrated angular deformity ( P = .035). The incidence of postoperative ipsilateral ACL tear was 16.7% in the all-epiphyseal group and 23.8% in the conventional group ( P = .757). The incidence of contralateral ACL tear was 11.1% in the all-epiphyseal group and 14.3% in the conventional group ( P ≥ .999). Conclusion: All-epiphyseal DB-ACL reconstruction for skeletally immature patients achieved satisfactory clinical outcomes compared with conventional DB-ACL reconstruction. The incidence of ipsilateral graft rupture was relatively high in both groups. The all-epiphyseal group had a significantly higher incidence of angular deformity.

All-epiphyseal anterior cruciate ligament reconstruction yields superior sports performances than the trans-epiphyseal technique in skeletally immature patients: a systematic review

“…[ 97 ] Medicine (Baltimore) Retrospective 66 19.2 All-epiphyseal 18 19 13.3 4 Sasaki et al. [ 98 ] Orthop J Sports Med Retrospective 74 41.6 All-epiphyseal 18 18 12.4 10 38.1 Trans-epiphyseal 84 84 14.1 75 Seon et al. [ 99 ] J Korean Med Sci Retrospective 58 77.7 Trans-epiphyseal 11 11 14.7 0 Shamrock et al.…”

The Risk of Growth Disturbance Is Low After Pediatric Anterior Cruciate Ligament Reconstruction With a Femoral Growth Plate Sparing Technique

“… 30 found a revision rate of 12%, and Sasaki et al. 33 reported a graft rupture rate of 16.7 to 23.8%, depending on the surgical technique.…”

Anterior cruciate ligament reconstruction in skeletally immature patients is effective: A systematic review

“…The prevalence of anterior cruciate ligament (ACL) tears in children and adolescents with open physes is raising [1,2]. Consequently, the number of ACL reconstructions in this population has also increased in the last decades [3,4]. Traditionally, ACL tears in skeletally immature patients were treated conservatively with bracing and physiotherapy, as ACL reconstruction techniques could damage the growing epiphyseal plates, potentially leading to growth disturbances, including leg-length discrepancy or angular deformities [5,6].…”