Anterior cruciate ligament reconstruction with the semitendinosus tendon in children

Summary

Objectives

Reconstruction of the anterior cruciate ligament in children without creating permanent damage to the tibial or femoral physes. The semitendinosus tendon, left attached distally, is passed through a tunnel in the tibial epiphysis, led through the joint, passed behind the lateral femoral condyle and fixed to the outer aspect of the femur with a staple.

Indications

Symptomatic or recurrent knee instability.

Impaired function of the knee.

Failure of conservative treatment.

Skeletally immature child with bone age less than 12 years.

Contraindications

Lack of motivation for rehabilitation.

Skeletally mature child.

Surgical Technique

After division of the semitendinosus tendon at its musculotendinous junction, the tendon is pulled into a second incision over the pes anserinus. It is then passed under the pes anserinus to the anteromedial flare of the tibia where a tunnel is drilled through the tibial epiphysis into the joint, the tendon is passed through this tunnel, led around the posterior aspect of the lateral femoral condyle and fixed with a staple over the outer aspect of the lateral femoral condyle.

Results

Between 1990 and 1998, 3 children (2 girls, 1 boy, average age: 15 years, 4 months) underwent this reconstruction with the semitendinosus transfer. The follow-up period ranged from 14 to 42 months with an average 19 months. Whereas all children had a positive Lachman sign preoperatively, 2 had a negative Lachman sign and 1 a Grade-I Lachman at follow-up. All children returned to their former sports activities with no complaints of instability or pain. The range of motion and the strength of the operated knee were full.