Pediatric Anterior Cruciate Ligament Reconstruction: A Systematic Review of Transphyseal Versus Physeal-Sparing Techniques

Pierce, Todd P.; Issa, Kimona; Festa, Anthony; Scillia, Anthony J.; McInerney, Vincent K.

doi:10.1177/0363546516638079

Cited by 73 publications

(75 citation statements)

References 46 publications

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“…The incidence of limb length and angular deformities was not different between the two cohorts. The rerupture rate in the transphyseal cohort was 6.2 % after 6-year follow-up, and 3.1 % in physeal sparing, though this was not a significant difference [54].…”

Section: Comparative Studiesmentioning

confidence: 73%

Anterior cruciate ligament reconstruction in skeletally immature patients

Pennock

Murphy

2016

Curr Rev Musculoskelet Med

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The management of pediatric patients with an anterior cruciate ligament (ACL) tear can be a challenging endeavor for physicians, athletic trainers, coaches, and parents alike. In particular, the significant longitudinal growth that arises from the physes about the knee creates a unique set of circumstances that must be considered in this patient population. The purpose of this review is to provide a summary of the most recent current literature for the management of skeletally immature patients with an ACL tear.

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Section: Comparative Studiesmentioning

confidence: 73%

Anterior cruciate ligament reconstruction in skeletally immature patients

Pennock

Murphy

2016

Curr Rev Musculoskelet Med

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“…2,3 To date, there is no convincing evidence to support a specific procedure for pediatric ACL reconstruction. 2,3 There is a variety in the duration of follow-up after ACL reconstruction among respondents in this survey. A third of the respondents did not respond to this item.…”

Section: Discussionmentioning

confidence: 99%

Current State of Care for Pediatric ACL Ruptures in the Netherlands: A Survey

et al. 2019

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The management of anterior cruciate ligament (ACL) injuries in the skeletally immature patient is an area of controversy. The purpose of this survey is to inventory the current state of care for pediatric ACL injuries in the Netherlands. This survey was conveyed by e-mail among all members of the Dutch Arthroscopy Society (Nederlandse Vereniging van Arthroscopie [NVA]) and promoted on the Web site of the NVA. It was developed by the scientific committee of the NVA by a consensus meeting discussing relevant topics in pediatric ACL injuries. All members of the NVA received the survey (n = 540). A total of 158 (29%) members responded to the survey, of which 143 were completed. A total of 126 responses were analyzed after exclusion. The main finding of this survey is that 78% of the respondents tend to treat children with open physes nonoperatively, while 65% tend to treat children with closed physes operatively. The most frequently performed procedure is the transphyseal reconstruction. Many considerations were involved in choosing operative treatment. The postoperative follow-up period varies from less than 1 year (24%) until fully grown (27%). In conclusion, this survey shows that the current state of care for pediatric ACL injuries is variable and a matter of debate in the Netherlands. Although the response rate seems low, this survey provides an overview of the opinions of specialized orthopaedic surgeons in the Netherlands. The results of this survey led to the development of the national registry for pediatric ACL in the Netherlands. The level of evidence for this study is V.

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“…The failure rate of 7.9%, all in the transphyseal group, is slightly higher than the 6.2% failure rate for transphyseal ACLR in recent a systematic review and almost double the 4.2% of patients with transphyseal ACLR in a meta-analysis of 935 skeletally immature patients. 23,24 Another important finding was the very low incidence of growth disturbance reported, with only one reported incidence of LLD (0.25%) and one angular deformity (0.25%, both in the same patient). The vast majority of patients (98%) underwent a transphyseal allograft ACLR technique with AT allografts.…”

Section: Discussionmentioning

confidence: 99%

Primary Allograft ACL Reconstruction in Skeletally Immature Patients—A Systematic Review of Surgical Techniques, Outcomes, and Complications

Shanmugaraj

Skelly

et al. 2018

J Knee Surg

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The purpose of this systematic review is to ascertain the risk profile of allografts in primary anterior cruciate ligament reconstruction (ACLR) of skeletally immature patients. Three databases (PubMed, EMBASE, and MEDLINE) were searched for articles addressing primary ACLR in skeletally immature patients (i.e., open femoral and tibial physes). Inclusion criteria encompassed the use of allograft tissue with available postoperative outcomes data. The methodological index for non-randomized studies (MINORS) was used to assess all studies. Descriptive statistics such as means, 95% confidence intervals and standard deviations are presented where applicable. A total of 3,852 studies were screened, with 9 studies of a total of 406 skeletally immature patients (mean age 14.9 ± 1.2 years) satisfying inclusion criteria. The majority (98%) of included patients underwent complete transphyseal ACLR. Where specified, allograft options included Achilles tendon (AT) (66.5%), tibialis anterior tendon (7.6%), bone-patellar tendon (2.5%), and fascia lata (1.0%). The use of a bone block for the AT was reported in one patient (0.2%). Postoperatively, and where specified, patients achieved full range of motion (12.1%), had good Lysholm scores of 94 to 100 (8.1%), and a return to preinjury level athletic participation of 82.9% (8.4%). Complications (13.3%) included graft failures (7.9%), nonrevision reoperation (4.7%), and a combined leg length discrepancy and angular (valgus and extension) deformity (0.2%). There were no reported incidences of disease transmission. Although failure rates of primary allograft ACL reconstruction are acceptable compared with other studies of mainly autograft use in this young, high-risk population, there was a very low rate of clinically significant physeal damage. However, the relatively low quality of the included studies limits the ability to recommend routine use of allograft for ACLR in the skeletally immature patient. More robust studies with long-term follow-up data are necessary to better ascertain the influence of allograft choice on postoperative outcomes for these young patients. This is a Level IV study, systematic review of Levels III and IV studies.

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Pediatric Anterior Cruciate Ligament Reconstruction: A Systematic Review of Transphyseal Versus Physeal-Sparing Techniques

Cited by 73 publications

References 46 publications

Anterior cruciate ligament reconstruction in skeletally immature patients

Anterior cruciate ligament reconstruction in skeletally immature patients

Current State of Care for Pediatric ACL Ruptures in the Netherlands: A Survey

Primary Allograft ACL Reconstruction in Skeletally Immature Patients—A Systematic Review of Surgical Techniques, Outcomes, and Complications

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