Abstract
Purpose
Significant controversy exists regarding the potential harm to the growth plate following reconstruction of the anterior cruciate ligament in skeletally immature patients. This study was performed to evaluate the results of a transepiphyseal replacement of the anterior cruciate ligament in skeletally immature patients.
Methods
Ninety-four skeletally immature patients (56 male and 38 female) with median age 13.7 years (range, 11.6–15.9 years) who underwent arthroscopic transphyseal reconstruction of anterior cruciate ligament with four-strand medial hamstring autograft between 1999 and 2006 were reviewed. All patients had been followed up until skeletal maturity was confirmed.
Results
The average follow-up was 38 months (range 24–60 months). Neither leg length discrepancy nor angular deformities were noted on radiological or clinical measurement. Two patients had radiographic evidence of mild arthrosis at final follow-up. New traumatic injuries occurred in 4 patients, in whom surgical revision was performed.
Ligament laxity testing with a KT 1000/2000 arthrometer showed no significant difference between the normal and the operated legs. At follow-up, the median Lysholm score was 89 (range 77–100), and the median Tegner activity score was increased from 3 to 6. The International Knee Documentation Committee score was A in 79 patients (84%) and B in 6 patients (6%) and C in 9 patients (9%). Of the 94 patients, 73 (78%) returned to their similar preoperative sport activities and 90% returned to their preoperative level of daily activities.
Conclusions
ACL reconstruction with medial hamstring autograft via transepiphyseal drilling and grafting yielded satisfactory clinical results with no growth defects in skeletally immature patient. The preliminary results of this series demonstrated that this surgical technique can be performed in prepubescent patients with efficacy and safety.
Level of evidence
IV.
Similar content being viewed by others
References
Airchoth PM, Patel DV, Zorilla P (2002) The natural history and treatment of rupture of the anterior cruciate ligament in children and adolescents. A prospective review. J Bone Joint Surg Br 84-B:38–41
Anderson AF (2003) Transepiphyseal replacement of the anterior cruciate ligament in skeletally immature patients: a preliminary report. J Bone Joint Surg [Am] 85-A:1255–1263
Arbes S, Resinger C, Vescei V, Nau T (2006) The functional outcome of total tears of the anterior cruciate ligament (ACL) in the skeletally immature patient. Int Orthop 31:471–475
Bales CP, Guettler JH, Moorman CT (2004) Anterior cruciate ligament injuries in children with open physes: evolving strategies of treatment. Am J Sports Med 32:1978–1985
Barrett GR, Field MH, Treacy SH, Ruff CG (1998) Clinical results of meniscus repair in patients 40 years and older. Arthroscopy 14:824–829
Beasley LS, Chudic SC (2003) Anterior cruciate ligament injury in children: update of current treatment options. Curr Opin Pediatr 15:45–52
Bollen S, Pease F, Ehrenraich A, Church S, Skinner J, Williams A (2008) Changes in the fourstrand hamstring graft in anterior cruciate ligament reconstruction in the skeletally immature knee. J Bone Joint Br 90-B:455–459
Cohen M, Ferretti M, Quarteiro M, Marcondes F, Hollanda JP, Amaro J, Abdalla R (2009) Transphyseal anterior cruciate ligament reconstruction in patients with open physes. Arthroscopy 25:831–838
Cooper DE, Arnoczky SP, Warren RF (1991) Meniscal repair. Clin Sports Med 10:529–548
Courvoisier A, Grimaldi M, Plaweski S (2010) Good surgical outcome of transphyseal ACL reconstruction in skeletally immature patients using four-strand hamstring graft. Knee Surg Sports Traumatol Arthrosc PMID:20890694
DeLee J, Curtis R (1983) Anterior cruciate ligament insufficiency in children. Clin Orthop Relat Res 172:112–118
Dorizas JA, Statinski CL (2003) Anterior cruciate ligament injury in the skeletally immature. Orthop Clin Noth Am 34:355–363
Edwards PH, Grana WA (2001) Anterior cruciate ligament reconstruction in the immature athlete: long-term results of intrarticular reconstruction. Am J Knee Surg 14:232–237
Engebretsen L, Svenningsen S, Benum P (1988) Poor results of anterior cruciate repair in adolescence. Acta Orthop Scand 59:684–686
Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Joint Surg Am 30-B:664–670
Gaulrapp HM, Haus J (2006) Intraarticular stabilization after anterior cruciate ligament tear in children and adolescents: results 6 years after surgery. Knee Surg Sports Traumatol Arthrosc 14:417–424
Guzzanti V, Falciglia F, Stantiski CL (2003) Physeal-sparing intraarticular anterior cruciate ligament reconstruction in preadolescents. Am J Sports Med 31:949–953
Guzzanti V, Falciglia F, Gigante A, Fabbriciani C (1994) The effect of intraarrticular ACL reconstruction on the growth plate of rabbits. J Bone Joint Surg Br 76:960–963
Henry J, Chotel F, Chouteau J, Fessy MH, Berard J, Moyen B (2009) Rupture of the ACL in children: early reconstruction or delayed reconstruction to skeletal maturity? Knee Surg Sports Traumatol Arthrosc 17:748–755
Irrgang JJ, Anderson AF, Boland AL et al (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613
Janarv PM, Nystrom A, Werner S, Hirsch G (1996) Anterior cruciate ligament injuries in skeletally immature patients. J Pediatr Orthop 16:673–677
Kaeding CC, Flanigan D, Donaldson C (2010) Surgical techniques and outcomes after anterior cruciate ligament in preadolescent patients. Arthroscopy 26:1530–1538
Kannus P, Jarvinen M (1988) Knee ligament injuries in adolescents. J Bone Joint Surg Br 70:772–776
Kocher MS, Garg S, Micheli LJ (2005) Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescents. J Bone Joint Surg Am 87:2371–2379
Kocher MS, Smith JT, Zoric BJ, Lee B, Ganley TJ (2007) Transphyseal anterior cruciate ligament reconstruction in skeletally immature prepubescent adolescents. J Bone Joint Surg Am 89-A:2632–2639
Liddle AD, Imbuldeniya AM, Hunt DM (2008) Transphyseal reconstruction of the anterior cruciate ligament in prepubescent children. J Bone Joint Surg Br 90-B:1317–1322
Lipscomb AB, Anderson AF (1986) Tears of the anterior cruciate ligament in adolescents. J Bone Joint Surg Am 68-A:19–28
McCarroll JR, Rettig AC, Shelbourne KD (1988) Anterior cruciate ligament injuries in the athlete with open physes. Am J Sports Med 16:45–47
McIntosh AL, Dahm DL, Stuart MJ (2009) Anterior cruciate ligament reconstruction in the skeletally immature patient. Arthroscopy 12:1325–1330
Millett PJ, Willis AA, Warren RF (2002) Associated injuries in pediatric and adolescent anterior cruciate ligament tears: does a delay in treatment increase the risk of meniscal tear? Arthroscopy 18:955–959
Mizuta H, Kubota K, Shiraishi M, Otsuka Y, Nagamoto N, Takagi K (1995) The conservative treatment of complete tears of the anterior cruciate ligament in skeletally immature patients. J Bone Joint Surg Br 77:890–894
Mohtadi N, Grant J (2006) Managing anterior cruciate ligament deficiency in skeletally immature individual: a systemic review of the literature. Clin J Sport Med 16:457–464
Moksnes H, Engebretsen L, Risberg MA (2008) Performance-based functional outcome for children 12 years or younger following anterior cruciate ligament injury: a two to nine-year follow-up study. Knee Surg Sports Traumatol Arthrosc 16:214–223
Paletta GA Jr (2003) Special considerations: anterior cruciate ligament reconstruction in skeletally immature. Orthop Clin North Am 34:65–77
Shea KG, Apel PJ, Pfeiffer Rp (2003) Anterior cruciate ligament injury in paediatric and adolescent patients: a review of basic science and clinical research. Sports Med 33:455–471
Shirakura K, Kobuna Y, Kizuki S, Terauchi M, Fukasawa N (1995) Untreated acute anterior cruciate ligament tears of the knee: progression and the influence of associated injuries. Knee Surg Sports Traumatol Arthrosc 3:62–67
Simonian PT, Metcalf MH, Larson RV (1999) Anterior cruciate ligament injuries in skeletally immature patient. Am J Orthop 28:624–628
Stadelmaier D, Arnoczky SDodds J, Ross H (1995) The effect of drilling a soft tissue grafting across open growth plates. Am J Sports Med 23:431–435
Stantisky CL (1998) Correlation of arthroscopic and clinical examinations with magnetic resonance imaging findings of injured knees in children and adolescent. Am J Sports Med 26:2–6
Streich NA, Barie A, Gotterbarm T, Keil M, Schmitt H (2010) Transphyseal reconstruction of the anterior cruciate ligament in prepubescent athletes. Knee Surg Sports Traumatol Arthrosc 18:1481–1486
Tanner JM, Whitehouse RH (1976) Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child 51:170–179
Tegner Y, lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198:43–49
Utukuri MM, Somayi HS, Khanduja V, Dowd GS, Hunt DM (2006) Update on paediatric ACL injuries. Knee 13:345–352
Vaquero J, Vidal C, Cubillo A (2005) Intra-articular disorders of the knee in the children nad adolescents. Clin Orthop Rel Research 432:97–106
Woods WG, O’Connor DP (2004) Delayed anterior cruciate ligament reconstruction in adolescents with open physes. Am J Sports Med 32:201–210
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nikolaou, P., Kalliakmanis, A., Bousgas, D. et al. Intraarticular stabilization following anterior cruciate ligament injury in children and adolescents. Knee Surg Sports Traumatol Arthrosc 19, 801–805 (2011). https://doi.org/10.1007/s00167-010-1375-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-010-1375-y