Original Article
Anterior Cruciate Ligament Reconstruction Using the Transphyseal Technique in Prepubescent Athletes: Midterm, Prospective Evaluation of Results

https://doi.org/10.1016/j.arthro.2015.11.045Get rights and content

Purpose

To evaluate the efficacy, results, and complications of transphyseal technique of anterior cruciate ligament (ACL) reconstruction in prepubertal patients and to assess a possible influence of children's growth on the outcome.

Methods

Between 2005 and 2009, 22 (16 boys and 6 girls) prepubescent patients, Tanner stage 1 and 2, underwent ACL reconstruction and the follow-up 6, 12, and 24 months after surgery and after growth plate closure. The average age of the girls was 11.2 years, and of the boys, 12.3 years. The average follow-up period was 77.2 months. Clinical outcome was evaluated by Lysholm, Tegner, and International Knee Documentation Committee (IKDC) objective and subjective knee scores. Standard radiograms were performed for potential axial growing disturbance.

Results

The average follow-up period was 77.2 months (range, 54 to 102 months), and IKDC subjective scores changed from 58 (range, 44 to 69) before surgery to 87 (range, 86 to 87; P = .00) at 6 months, 93 (range, 88 to 97; P = .00) at 12 months, and 95 (range, 92 to −98; P = .5) at final examination. Lysholm score increased from 58 (range, 53 to 64) before surgery to 89 (range, 85 to 92; P = .00) at 6 months and 96 (range, 94 to 100; P = .00) at 12 months, 24 months (P = .9), and final examination (P = .8). Before injury, all patients were graded 7 on the Tegner scale. Nineteen athletes reached at least grade 7 and returned to the level of activity a mean of 9 months after the surgery. No patient had deformity or growth disturbances observed clinically.

Conclusions

Arthroscopic-assisted transphyseal ACL reconstruction in prepubescent patient is a promising technique, provided that all technical details are respected. It gives excellent subjective and objective knee scores and provides a very good function of the knee joint in the midterm period with no or only minor effect on the leg length. The rate of growth after surgery did not influence the results.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Methods

After obtaining Institutional Review Board approval, all prepubescent children with poorly tolerated ACL-deficient knees admitted to our hospital for ACL reconstruction were enrolled for this study. At the beginning we assessed stage of maturation using Tanner criteria and selected for further analysis only children who were in Tanner stages 1 and 2. All children with pubic hairs over pubis, axiliary hairs, acne, and voice changes as well as patients with limb deformities, systemic disorders,

Results

Between 2005 and 2009, 22 skeletally prepubescent patients met our inclusion criteria (Fig 1). There were 16 boys and 6 girls. The average chronological age of girls was 11.2 (range, 10.6 to 11.8) years and of boys, 12.3 (range, 10.5 to 13.2) years (Table 1). At the final follow-up, the average age was 17.6 (range, 16.5 to 18.3) years for girls and 18.8 (range, 16.1 to 20.2) years for boys. Causes of injury were solely sport related. The average interval between the ACL injury and the time of

Discussion

Our study showed that transphyseal ACL reconstruction in prepubescent Tanner 1 and 2 patients is a promising and relatively safe technique giving good knee function and excellent subjective and objective knee scores in the midterm follow-up, and the rate of the remaining growth after surgery has no impact on the outcomes.

There were some growth complications around the knee joint reported in the literature.4, 25 The study of the Herodicus Society uncovered 15 cases (11%) of iatrogenic epiphyseal

Conclusions

Arthroscopic-assisted transphyseal ACL reconstruction in prepubescent patients is a promising technique provided that all technical details are respected, gives excellent subjective and objective knee scores, and provides a very good function of the knee joint in the midterm period with no or only minor effect on the leg length. The rate of growth after surgery did not influence the results.

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    The authors report that they have no conflicts of interest in the authorship and publication of this article.

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