Outcome of Anatomic Transphyseal Anterior Cruciate Ligament Reconstruction in Tanner Stage 1 and 2 Patients With Open Physes
Background: Anterior cruciate ligament (ACL) injuries are being seen with increasing frequency in children. Treatment of the ACL-deficient knee in skeletally immature patients is controversial.
Purpose: To determine the outcome of all-arthroscopic transphyseal anatomic single-bundle ACL reconstruction in Tanner stage 1 and 2 patients at a minimum of 2 years after surgery.
Study Design: Case series; Level of evidence, 4.
Methods: Between 2007 and 2008, 16 prepubescent patients underwent ACL reconstruction using soft tissue grafts. All patients were Tanner stage 1 and 2. Outcomes were assessed at a minimum of 2 years after surgery and included limb alignment, limb length, instrumented testing with the KT-1000 arthrometer, and International Knee Documentation Committee (IKDC) score.
Results: Mean age at the time of surgery was 12 years (range, 8-14 years). Graft choices included the following: living donor–related hamstring tendon allograft (n = 14), hamstring tendon autograft (n = 1), and fresh-frozen allograft (n = 1). Mean IKDC subjective score was 96 (range, 84-100). All patients had a stable knee postoperatively. Eleven patients had a negative Lachman test result, and 14 had a negative pivot-shift test result. The remainder had grade 1 Lachman and pivot-shift test findings, respectively. At 2 years after surgery, all patients had returned to strenuous activities, and normal or nearly normal overall IKDC score was documented in 94% of patients. There were no cases of limb malalignment or growth arrest.
Conclusion: We present a case series of transphyseal anatomic single-bundle ACL reconstruction in Tanner stage 1 and 2 patients at a minimum of 2 years after surgery. Excellent clinical outcomes were obtained with high levels of return to desired activities. Importantly, no growth disturbances were seen in this series of patients.
Hui, C., Roe, J., Ferguson, D., Waller, A., Salmon, L., & Pinczewski, L. (2012). Outcome of anatomic transphyseal anterior cruciate ligament reconstruction in Tanner Stage 1 and 2 patients with open physes. American Journal of Sports Medicine, 40(5), 1093-1098. doi:10.1177/0363546512438508