Transphyseal reconstruction of the anterior cruciate ligament in prepubescent athletes

Abstract

ACL reconstruction in adolescents undergoing or being beyond the final growth spurt can be performed as in adults without major concern of growth disturbance. Whereas for the young athlete with wide-open physis a lot of controversy still exists about the technical aspect of the procedure to minimise the risk of growth disturbance. Between 10/1997 and 10/2002 31 children graded Tanner stage 1 or 2 (median age 11 years) with an intraligamental rupture of the anterior cruciate ligament were enrolled. Seventeen patients with coexisting intraarticular damage (meniscus, osteochondral flake) underwent transphsyeal reconstruction of the ACL with the use of an autogenous semitendinosus tendon graft, whereas 14 patients without coexisting pathologies received a nonoperative regime. Growth disturbance, functional and radiographic outcome could be evaluated in 28 patients at a median of 70 months after initial treatment. No patient had clinical or radiological evidence for varus/valgus malalignment or leg length discrepancy. The mean of subsequent body growth within the study population was 20.3 cm. Patients operated on revealed significant (P < 0.05) better clinical (KT-1000 side-to-side difference, pivot shift) and functional results according to the IKDC (median, 95 vs. 87), Lysholm (median, 93 vs. 84) and the Tegner score. More than half of the conservatively treated patients (58%) had subsequent surgery due to persistent instability. Transphyseal reconstruction of intraligamental ACL ruptures with an autologous ST graft yielded superior clinical results if compared to a nonoperative treatment in immature prepubescent patients being Tanner stage 1 and 2.

Reconstruction of the chronic anterior unstable sternoclavicular joint using a tendon autograft: medium-term to long-term follow-up results

“…It is known from the literature of anterior cruciate ligament reconstruction in children with open physes that the complications are few. 22 One of the failures was an atraumatic failure in a 14-yearold boy. After revision, he remained stable.…”

All-Epiphyseal, All-Inside Anterior Cruciate Ligament Reconstruction Technique for Skeletally Immature Patients

“…The descriptions that do exist limit early weight bearing and ROM. 44,61,62 It is not recommended to follow adult ACL reconstruction guidelines for patients who have received physealsparing ACL reconstruction because of differing fixation technique as well as patient maturity level. Isometric graft placement allows for immediate motion without adverse loads.…”

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

“…5,25,27,39 Many techniques have been described for ACL reconstruction in skeletally immature patients. 6,9,28 Transphyseal ACL reconstruction involves drilling bone tunnels across an open physis and fixing a soft tissue graft away from the physis.…”