Nonanatomic anterior cruciate ligament reconstruction with double-stranded semitendinosus grafts in children with open physes: minimum 15-year follow-up

Background: Nonanatomic anterior cruciate ligament (ACL) reconstruction (ACLR) with double-stranded semitendinosus grafts in children with open physes has been described as a successful surgical technique in short-term follow-up clinical reports.

Purpose: To evaluate the clinical outcomes of nonanatomic ACLR in children with open physes and a minimum of 15 years' follow-up.

Study design: Case series; Level of evidence, 4.

Methods: Twelve patients with an average age of 10.7 years (range, 8.3-12.4 years) underwent ACLR between 1991 and 1998. All patients were classified as Tanner development stage 2 or lower. The surgical technique involved transphyseal tibial tunnel drilling and over-the-top (OTT) femoral fixation using a double-stranded graft for all patients. Clinical outcomes were evaluated in terms of the manual Lachman test, pivot-shift test, return to sports activity, and International Knee Documentation Committee (IKDC) score at the end of growth and at a minimum 15-year follow-up (range, 15-22 years).

Results: No clinically significant growth disturbance was observed. Ten patients had a grade A IKDC score, and 2 patients had a grade B IKDC score at the end of growth. There was no progression of laxity or modification of knee stability with growth. Three patients (25%) had ACL reruptures during sports activities after growth plate closure. All patients with reruptured ACLs underwent additional reconstructive surgery.

Conclusion: Anterior cruciate ligament reconstruction using the OTT technique in the femur and the transphyseal technique in the tibia produces good results with regard to growth plate closure but a high failure rate in adulthood.