Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleAnterior Cruciate Ligament Reconstruction Using the Transphyseal Technique in Prepubescent Athletes: Midterm, Prospective Evaluation of Results
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 Risk of Growth Disturbance Is Low After Pediatric Anterior Cruciate Ligament Reconstruction With a Femoral Growth Plate Sparing Technique
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2020, Arthroscopy, Sports Medicine, and RehabilitationCitation Excerpt :Agreement between the 2 primary reviewers had a free marginal kappa of 0.67, indicative of substantial agreement.31 Seventy-seven articles reporting the clinical outcomes of pediatric and adolescent patients undergoing ACL reconstruction were analyzed.31-107 Studies were performed by primary authors from 17 different countries and published in 20 different peer-reviewed journals, dated between 1986 and 2018 (Fig 2).
Complications in Pediatric Anterior Cruciate Ligament Surgery: Transphyseal in Skeletally Immature Patients
2020, Complications in Orthopaedics: Sports MedicinePrimary Anterior Cruciate Ligament Repair With Hyaluronic Scaffold and Autogenous Bone Marrow Aspirate Augmentation in Adolescents With Open Physes
2019, Arthroscopy TechniquesCitation Excerpt :The main objective of all surgical techniques in adolescents is to avoid potential iatrogenic growth plate injury. “Physeal-sparing” techniques such as over-the-top reconstructions of the femur and tibia and iliotibial band reconstructions, all-epiphyseal, and transphyseal reconstruction were developed.8-12 There are notable disadvantages of ACLR that include loss of proprioception, donor side morbidity, incomplete return to high-demand sports, and the inability to restore normal kinematics of the knee joint.13-15
The authors report that they have no conflicts of interest in the authorship and publication of this article.