Skip to main content
SpringerLink
Log in

Transphyseal reconstruction of the anterior cruciate ligament in prepubescent athletes

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

ACL reconstruction in adolescents undergoing or being beyond the final growth spurt can be performed as in adults without major concern of growth disturbance. Whereas for the young athlete with wide-open physis a lot of controversy still exists about the technical aspect of the procedure to minimise the risk of growth disturbance. Between 10/1997 and 10/2002 31 children graded Tanner stage 1 or 2 (median age 11 years) with an intraligamental rupture of the anterior cruciate ligament were enrolled. Seventeen patients with coexisting intraarticular damage (meniscus, osteochondral flake) underwent transphsyeal reconstruction of the ACL with the use of an autogenous semitendinosus tendon graft, whereas 14 patients without coexisting pathologies received a nonoperative regime. Growth disturbance, functional and radiographic outcome could be evaluated in 28 patients at a median of 70 months after initial treatment. No patient had clinical or radiological evidence for varus/valgus malalignment or leg length discrepancy. The mean of subsequent body growth within the study population was 20.3 cm. Patients operated on revealed significant (P < 0.05) better clinical (KT-1000 side-to-side difference, pivot shift) and functional results according to the IKDC (median, 95 vs. 87), Lysholm (median, 93 vs. 84) and the Tegner score. More than half of the conservatively treated patients (58%) had subsequent surgery due to persistent instability. Transphyseal reconstruction of intraligamental ACL ruptures with an autologous ST graft yielded superior clinical results if compared to a nonoperative treatment in immature prepubescent patients being Tanner stage 1 and 2.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Aichroth PM, Patel DV, Zorrilla 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 84:38–41

    Article  CAS  PubMed  Google Scholar 

  2. Anderson AF (2003) Transepiphyseal replacement of the anterior cruciate ligament in skeletally immature patients. A preliminary report. J Bone Joint Surg Am 85:1255–1263

    PubMed  Google Scholar 

  3. Andrews M, Noyes FR, Barber-Westin SD (1994) Anterior cruciate ligament allograft reconstruction in the skeletally immature athlete. Am J Sports Med 22:48–54

    Article  CAS  PubMed  Google Scholar 

  4. Aronowitz ER, Ganley TJ, Goode JR, Gregg JR, Meyer JS (2000) Anterior cruciate ligament reconstruction in adolescents with open physes. Am J Sports Med 28:168–175

    CAS  PubMed  Google Scholar 

  5. Behr CT, Potter HG, Paletta GA Jr (2001) The relationship of the femoral origin of the anterior cruciate ligament and the distal femoral physeal plate in the skeletally immature knee. An anatomic study. Am J Sports Med 29:781–787

    CAS  PubMed  Google Scholar 

  6. Bisson LJ, Wickiewicz T, Levinson M, Warren R (1998) ACL reconstruction in children with open physes. Orthopedics 21:659–663

    CAS  PubMed  Google Scholar 

  7. Fuchs R, Wheatley W, Uribe JW, Hechtman KS, Zvijac JE, Schurhoff MR (2002) Intra-articular anterior cruciate ligament reconstruction using patellar tendon allograft in the skeletally immature patient. Arthroscopy 18:824–828

    Article  PubMed  Google Scholar 

  8. Graf BK, Lange RH, Fujisaki CK, Landry GL, Saluja RK (1992) Anterior cruciate ligament tears in skeletally immature patients: meniscal pathology at presentation and after attempted conservative treatment. Arthroscopy 8:229–233

    Article  CAS  PubMed  Google Scholar 

  9. Grontvedt T, Engebretsen L, Benum P, Fasting O, Molster A, Strand T (1996) A prospective, randomized study of three operations for acute rupture of the anterior cruciate ligament. Five-year follow-up of one hundred and thirty-one patients. J Bone Joint Surg Am 78:159–168

    CAS  PubMed  Google Scholar 

  10. Guzzanti V, Falciglia F, Stanitski CL (2003) Physeal-sparing intraarticular anterior cruciate ligament reconstruction in preadolescents. Am J Sports Med 31:949–953

    PubMed  Google Scholar 

  11. Hawkins RJ, Misamore GW, Merritt TR (1986) Follow-up of the acute nonoperated isolated anterior cruciate ligament tear. Am J Sports Med 14:205–210

    Article  CAS  PubMed  Google Scholar 

  12. Janarv PM, Nystrom A, Werner S, Hirsch G (1996) Anterior cruciate ligament injuries in skeletally immature patients. J Pediatr Orthop 16:673–677

    CAS  PubMed  Google Scholar 

  13. Janarv PM, Wikstrom B, Hirsch G (1998) The influence of transphyseal drilling and tendon grafting on bone growth: an experimental study in the rabbit. J Pediatr Orthop 18:149–154

    Article  CAS  PubMed  Google Scholar 

  14. Kocher MS, Foreman ES, Micheli LJ (2003) Laxity and functional outcome after arthroscopic reduction and internal fixation of displaced tibial spine fractures in children. Arthroscopy 19:1085–1090

    Article  PubMed  Google Scholar 

  15. Kocher MS, Micheli LJ, Gerbino P, Hresko MT (2003) Tibial eminence fractures in children: prevalence of meniscal entrapment. Am J Sports Med 31:404–447

    PubMed  Google Scholar 

  16. Kocher MS, Saxon HS, Hovis WD, Hawkins RJ (2002) Management and complications of anterior cruciate ligament injuries in skeletally immature patients: survey of the Herodicus Society and The ACL Study Group. J Pediatr Orthop 22:452–457

    Article  PubMed  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. Koman JD, Sanders JO (1999) Valgus deformity after reconstruction of the anterior cruciate ligament in a skeletally immature patient. A case report. J Bone Joint Surg Am 81:711–715

    CAS  PubMed  Google Scholar 

  19. Lipscomb AB, Anderson AF (1986) Tears of the anterior cruciate ligament in adolescents. J Bone Joint Surg Am 68:19–28

    CAS  PubMed  Google Scholar 

  20. Lo IK, Kirkley A, Fowler PJ, Miniaci A (1997) The outcome of operatively treated anterior cruciate ligament disruptions in the skeletally immature child. Arthroscopy 13:627–634

    Article  CAS  PubMed  Google Scholar 

  21. Matava MJ, Siegel MG (1997) Arthroscopic reconstruction of the ACL with semitendinosus-gracilis autograft in skeletally immature adolescent patients. Am J Knee Surg 10:60–69

    CAS  PubMed  Google Scholar 

  22. McCarroll JR, Rettig AC, Shelbourne KD (1988) Anterior cruciate ligament injuries in the young athlete with open physes. Am J Sports Med 16:44–47

    Article  CAS  PubMed  Google Scholar 

  23. McCarroll JR, Shelbourne KD, Porter DA, Rettig AC, Murray S (1994) Patellar tendon graft reconstruction for midsubstance anterior cruciate ligament rupture in junior high school athletes. An algorithm for management. Am J Sports Med 22:478–484

    Article  CAS  PubMed  Google Scholar 

  24. McIntosh AL, Dahm DL, Stuart MJ (2006) Anterior cruciate ligament reconstruction in the skeletally immature patient. Arthroscopy 22:1325–1330

    Article  PubMed  Google Scholar 

  25. 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

    CAS  PubMed  Google Scholar 

  26. Mohtadi N, Grant J (2006) Managing anterior cruciate ligament deficiency in the skeletally immature individual: a systematic review of the literature. Clin J Sport Med 16:457–464

    Article  PubMed  Google Scholar 

  27. Odensten M, Gillquist J (1985) Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg Am 67:257–262

    CAS  PubMed  Google Scholar 

  28. Parker AW, Drez D Jr, Cooper JL (1994) Anterior cruciate ligament injuries in patients with open physes. Am J Sports Med 22:44–47

    Article  CAS  PubMed  Google Scholar 

  29. Schmitt H, Kappel H, Moser MT, Cardenas-Montemayor E, Engelleiter K, Kuni B, Clarius M (2008) Determining knee joint alignment using digital photographs. Knee Surg Sports Traumatol Arthrosc 16:776–780

    Article  PubMed  Google Scholar 

  30. Stadelmaier DM, Arnoczky SP, Dodds J, Ross H (1995) The effect of drilling and soft tissue grafting across open growth plates. A histologic study. Am J Sports Med 23:431–435

    Article  CAS  PubMed  Google Scholar 

  31. Tanner JM, Davies PS (1985) Clinical longitudinal standards for height and height velocity for North American children. J Pediatr 107:317–329

    Article  CAS  PubMed  Google Scholar 

  32. Vaquero J, Vidal C, Cubillo A (2005) Intra-articular traumatic disorders of the knee in children and adolescents. Clin Orthop Relat Res 432:97–106

    Article  PubMed  Google Scholar 

  33. Woods GW, O’Connor DP (2004) Delayed anterior cruciate ligament reconstruction in adolescents with open physes. Am J Sports Med 32:201–221

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Sports Medicine, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany

    Nikolaus A. Streich, Alexander Barié, Tobias Gotterbarm, Maximilian Keil & Holger Schmitt

Authors
  1. Nikolaus A. Streich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexander Barié
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tobias Gotterbarm
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maximilian Keil
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Holger Schmitt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nikolaus A. Streich.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Streich, N.A., Barié, A., Gotterbarm, T. et al. Transphyseal reconstruction of the anterior cruciate ligament in prepubescent athletes. Knee Surg Sports Traumatol Arthrosc 18, 1481–1486 (2010). https://doi.org/10.1007/s00167-010-1057-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-010-1057-9

Keywords

Search

Navigation