Advertisement

Intraarticular hamstring graft diameter decreases with continuing knee growth after ACL reconstruction with open physes

  • Diego Costa Astur
  • Gustavo Gonçalves Arliani
  • Pedro Debieux
  • Camila Cohen Kaleka
  • Joicemar Tarouco Amaro
  • Moises Cohen
Knee

Abstract

Purpose

To evaluate the graft diameter size after one-year follow-up or more of patients Tanner II, III, and IV who were submitted to anterior cruciate ligament reconstruction.

Methods

Ten patients [five males (mean age: 14.4 years) and five females (mean age: 13.6 years)] with open physis and anterior cruciate ligament tear were submitted to transphyseal anterior cruciate ligament reconstruction with quadruple hamstrings graft. During the procedure, graft and tunnel size were recorded. After last clinical follow-up (range 1–11 years), an MRI study was requested and their measurements near the tibial tunnel were compared with the graft diameter measured and used during primary procedure.

Results

Four patients had Tanner stage II, four patients Tanner stage III, and two Tanner IV. There were statistically significant decreases in the quadruple hamstrings graft diameter size (average of 25.3 %). Mean size at time of surgery was 7.9 mm (±0.87), and mean size measured at different points of follow-up evaluation was 5.9 mm (±0.65).

Conclusion

Diameter size of hamstring graft in skeletally immature patients is smaller in most cases. If there is a decrease in the diameter of the graft along postoperative time, the risk of a re-rupture is theoretically further increased. Quadruple hamstring graft decreases a mean 25.3 % in diameter from time of anterior cruciate ligament reconstruction surgery until reassessment period in skeletally immature patients.

Level of evidence

IV.

Keywords

Anterior cruciate ligament Tanner stage ACL reconstruction Open physis Children Graft evaluation 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

References

  1. 1.
    Al-Hadithy N, Dodds AL, Akhtar KS, Gupte CM (2013) Current concepts of the management of anterior cruciate ligament injuries in children. Bone Joint J 95-B(11):1562–1569CrossRefPubMedGoogle Scholar
  2. 2.
    Astur DC, Castro S, Bernardes A, Cohen M (2015) Unusual case of a surgically treated ACL tear in a 4-year-old patient. BMJ Case Rep. doi: 10.1136/bcr-2015-210817 PubMedGoogle Scholar
  3. 3.
    Astur DC, Lauxen D, Ejnisman B, Cohen M (2014) Twin athlete brothers with open physes operated for ACL reconstruction on the same day, but with different elapsed times after injury: a 5-year follow-up. BMJ Case Rep. doi: 10.1136/bcr-2013-202650 PubMedCentralPubMedGoogle Scholar
  4. 4.
    Babu S, Al-Obaidi B, Abdul-Jabar HB, Al-Hadithy N, Gupte C (2015) Knee injury in a 12 year old girl. BMJ 351:h3420. doi: 10.1136/bmj.h3420 CrossRefPubMedGoogle Scholar
  5. 5.
    Bollen S, Pease F, Ehrenraich A, Church S, Skinner J, Williams A (2008) Changes in the four-strand hamstring graft in anterior cruciate ligament reconstruction in the skeletally immature knee. J Bone Joint Surg Br 90(4):455–459CrossRefPubMedGoogle Scholar
  6. 6.
    Cohen M, Ferretti M, Quarteiro M, Marcondes FB, de Hollanda JP, Amaro JT, Abdalla RJ (2009) Transphyseal anterior cruciate ligament reconstruction in patients with open physes. Arthroscopy 25(8):831–838CrossRefPubMedGoogle Scholar
  7. 7.
    Cruz AI Jr, Fabricant PD, McGraw M, Rozell JC, Ganley TJ, Wells L (2015) All-epiphyseal ACL reconstruction in children: review of safety and early complications. J Pediatr Orthop. doi: 10.1097/BPO.0000000000000606 Google Scholar
  8. 8.
    Csintalan RP, Inacio MC, Desmond JL, Funahashi TT (2013) Anterior cruciate ligament reconstruction in patients with open physis: early outcomes. J Knee Surg 26(4):225–232CrossRefPubMedGoogle Scholar
  9. 9.
    Davis DL, Chen L, Ehinger M (2014) A study of epiphyses in the young prepubescent knee using magnetic resonance imaging: evaluation of parameters for anterior cruciate ligament reconstruction. Orthop J Sports Med 2(4):2325967114530090PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Demange MK, Camanho GL (2014) Nonanatomic anterior cruciate ligament reconstruction with double-stranded semitendinosus grafts in children with open physes: minimum 15-year follow-up. Am J Sports Med 42(12):2926–2932CrossRefPubMedGoogle Scholar
  11. 11.
    Dodwell ER, Lamont LE, Green DW, Pan TJ, Marx RG, Lyman S (2014) 20 years of pediatric anterior cruciate ligament reconstruction in New York State. Am J Sports Med 42(3):675–680CrossRefPubMedGoogle Scholar
  12. 12.
    Ergun M, Tasiran E (2004) Anterior cruciate ligament reconstruction in skeletally immature patients. Acta Orthop Traumatol Turc 38(Suppl 1):101–107PubMedGoogle Scholar
  13. 13.
    Fabricant PD, Jones KJ, Delos D, Cordasco FA, Marx RG, Pearle AD, Warren RF, Green DW (2013) Reconstruction of the anterior cruciate ligament in the skeletally immature athlete: a review of current concepts: AAOS exhibit selection. J Bone Joint Surg Am 95(5):e28CrossRefPubMedGoogle Scholar
  14. 14.
    Farrow LD, Liu RW (2010) Lateral anatomic structures at risk during transepiphyseal anterior cruciate ligament reconstruction. J Knee Surg 23(4):209–213CrossRefPubMedGoogle Scholar
  15. 15.
    Fauno P, Rahr-Wagner L, Lind M (2014) Risk for revision after anterior cruciate ligament reconstruction is higher among adolescents: results from the Danish registry of Knee ligament reconstruction. Orthop J Sports Med 2(10):2325967114552405PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Frank JS, Gambacorta PL (2013) Anterior cruciate ligament injuries in the skeletally immature athlete: diagnosis and management. J Am Acad Orthop Surg 21:78–87CrossRefPubMedGoogle Scholar
  17. 17.
    Funahashi KM, Moksnes H, Maletis GB, Csintalan RP, Inacio MC, Funahashi TT (2014) Anterior cruciate ligament injuries in adolescents with open physis: effect of recurrent injury and surgical delay on meniscal and cartilage injuries. Am J Sports Med 42(5):1068–1673CrossRefPubMedGoogle Scholar
  18. 18.
    Lemaitre G, Salle de Chou E, Pineau V, Rochcongar G, Delforge S, Bronfen C, Haumont T, Hulet C (2014) ACL reconstruction in children: a transphyseal technique. Orthop Traumatol Surg Res 100(4 Suppl):S261–S265CrossRefPubMedGoogle Scholar
  19. 19.
    Ludwig M, Atanda A Jr (2015) Management of anterior cruciate ligament tears in skeletally immature athletes. Phys Sportsmed 43(4):440–447CrossRefPubMedGoogle Scholar
  20. 20.
    Masaracchio M, Comet S, Godwin E (2015) Management of an anterior cruciate ligament tear in a 5 Year-old boy. Pediatr Phys Ther 27(3):302–310CrossRefPubMedGoogle Scholar
  21. 21.
    Milewski MD, Beck NA, Lawrence JT, Ganley TJ (2011) Anterior cruciate ligament reconstruction in the young athlete: a treatment algorithm for the skeletally immature. Clin Sports Med 30:801–810CrossRefPubMedGoogle Scholar
  22. 22.
    Morgan MD, Salmon LJ, Waller A, Roe JP, Pinczewski LA (2016) Fifteen-year survival of endoscopic anterior cruciate ligament reconstruction in patients aged 18 years and younger. Am J Sports Med. doi: 10.1177/0363546515623032 PubMedGoogle Scholar
  23. 23.
    Moksnes H, Engebretsen L, Seil R (2015) The ESSKA paediatric anterior cruciate ligament monitoring initiative. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-015-3746-x Google Scholar
  24. 24.
    Moksnes H, Grindem H (2015) Prevention and rehabilitation of paediatric anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-015-3856-5 Google Scholar
  25. 25.
    Nikolaou P, Kalliakmanis A, Bousgas D, Zourntos S (2011) Intraarticular stabilization following anterior cruciate ligament injury in children and adolescents. Knee Surg Sports Traumatol Arthrosc 19(5):801–805CrossRefPubMedGoogle Scholar
  26. 26.
    Parikh SN (2011) Transepiphyseal replacement of the anterior cruciate ligament in skeletally immature patients: a preliminary report. J Bone Joint Surg Am 93(4):e12PubMedGoogle Scholar
  27. 27.
    Straka M (2013) Anterior cruciate ligament injuries in children and adolescents in our patient group. Acta Chir Orthop Traumatol Cech 80(2):155–158PubMedGoogle Scholar
  28. 28.
    Tanner JM, Whitehouse RH (1976) Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child 51:170–179PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Tercier S, Zambelli PY (2013) Anterior cruciate ligament injuries in children. Rev Med Suisse 9(393):1408–1413PubMedGoogle Scholar
  30. 30.
    Werner BC, Yang S, Looney AM, Gwathmey FW Jr (2015) Trends in pediatric and adolescent anterior cruciate ligament injury and reconstruction. J Pediatr Orthop. doi: 10.1097/BPO.0000000000000482 Google Scholar
  31. 31.
    Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD (2016) Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports MedGoogle Scholar
  32. 32.
    Ziebarth K, Kolp D, Kohl S, Slongo T (2013) Anterior cruciate ligament injuries in children and adolescents: a review of the recent literature. Eur J Pediatr Surg 23(6):464–469CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • Diego Costa Astur
    • 1
  • Gustavo Gonçalves Arliani
    • 1
  • Pedro Debieux
    • 1
  • Camila Cohen Kaleka
    • 2
  • Joicemar Tarouco Amaro
    • 2
  • Moises Cohen
    • 1
  1. 1.Universidade Federal de São Paulo/Escola Paulista de MedicinaSão PauloBrazil
  2. 2.Instituto CohenSão PauloBrazil

Personalised recommendations