Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleTransphyseal Anterior Cruciate Ligament Reconstruction in Patients With Open Physes
Section snippets
Methods
We retrospectively evaluated 26 skeletally immature patients who underwent a transphyseal ACL reconstruction from July 2000 to July 2006 and who agreed to participate in this study. Inclusion criteria for the study included a minimum of 2 years' follow-up and age of 15 years or less for male patients and 14 years or less for female patients. No patient had any symptom or history of knee injury before the occurrence of ACL rupture. All patients underwent a radiologic study to evaluate bone
Radiologic Assessment
The length of the operated limb was increased compared with that of the contralateral limb. The total mean length difference was 1.2 ± 3.2 mm (range, −7 to 7 mm), but this was not statistically significant (P = .227). The length of the operated limb was decreased compared with the contralateral limb in only 5 patients. The mean length difference in the patients with decreased operated limb length was 3.6 mm (range, 2.0 to 7.0 mm). Eight patients had no difference in the lengths of their lower
Discussion
ACL injury in patients with open physes is an important topic in the clinical orthopaedic literature, because it may cause complications with both surgical and conservative treatments.12, 13, 14, 15, 16 Although there exists the option of performing ACL surgery only after the physes have matured, this method is no longer advocated because of poor clinical outcomes.12, 13, 22 Nonoperative treatment with modification of physical activities may be an effective way to prevent further damage to the
Conclusions
ACL reconstruction by use of the transphyseal technique in an immature skeleton with a hamstring autograft, with careful attention being paid to the technique, resulted in good clinical outcomes and no growth abnormalities.
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Cited by (104)
Multiligament Knee Injuries in Young Athletes
2022, Clinics in Sports MedicineOutcomes, Including Graft Tears, Contralateral Anterior Cruciate Ligament Tears, and All-Cause Ipsilateral Knee Operations, are Similar for Adult-type, Transphyseal, and Partial Transphyseal Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft in Pediatric and Adolescent Patients
2022, Arthroscopy, Sports Medicine, and RehabilitationCitation Excerpt :Surgical technique selection in the pediatric and adolescent population is dictated in large part by estimated growth remaining. Although growth abnormalities are legitimate concerns of transphyseal drilling and fixation that may be under-reported,46 many studies demonstrate that in the appropriate patient, minimal clinically relevant growth abnormalities may be noted using appropriate transphyseal techniques.15,40,47-50 A magnetic resonance imaging study demonstrated physeal violations with transphyseal techniques on both the femoral and tibial sides to be less than 4%, suggesting low likelihood of noticeable abnormality.51
Which Metrics Are Being Used to Evaluate Children and Adolescents After ACL Reconstruction? A Systematic Review
2020, Arthroscopy, Sports Medicine, and RehabilitationKnee and Leg Injuries
2020, Emergency Medicine Clinics of North AmericaCitation Excerpt :Previous guidelines advised delayed reconstruction until skeletal maturity had been achieved. However, current recommendations encourage immediate reconstruction, because this approach has shown a significantly lower rate of postinjury meniscal tears.58,59 Orthopedic surgeons use a variety of ACL reconstruction techniques.
The Paediatric Knee
2020, Evidence-Based Management of Complex Knee Injuries: Restoring the Anatomy to Achieve Best Outcomes
The authors report no conflict of interest.