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Physeal-sparing ACL reconstruction provides better knee laxity restoration but similar clinical outcomes to partial transphyseal and complete transphyseal approaches in the pediatric population: a systematic review and meta-analysis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this meta-analysis was to evaluate complete transphyseal (CTP), partial transphyseal (PTP), and physeal-sparing (PS) techniques for anterior cruciate ligament (ACL) reconstruction.

Methods

A systematic literature search of the PubMed, Web of Science, Cochrane Library, and Scopus literature databases was performed on 10.05.2021. All human studies evaluating the outcomes of CTP, PTP, and PS techniques were included. The influence of the selected approach was evaluated in terms of rates of retears, return to previous level of sport competition, IKDC subjective and objective scores, Lysholm score, rate of normal Lachman and pivot-shift tests, limb length discrepancy, and hip–knee angle (HKA) deviation. Risk of bias and quality of evidence were assessed following the Downs and Black checklist.

Results

Forty-nine out of 425 retrieved studies (3260 patients) met the inclusion criteria. The results of the meta-analysis comparing CTP, PTP, and PS approaches for ACL reconstruction in the under 20-year-old population showed a significant difference in terms of differential laxity (CTP 1.98 mm, PTP 1.69 mm, PS 0.22 mm, p < 0.001). No significant differences were seen in terms of growth malalignment, rate of normal Lachman and pivot-shift tests, and rate of normal/quasi-normal IKDC objective score.

Conclusions

The present meta-analysis found overall similar results with the three ACL reconstruction approaches. The PS technique showed better results in terms of knee laxity than the PTP and CTP approaches, but this did not lead to a significant difference in terms of subjective and objective scores. No clear superiority of one technique over the others was found with respect to re-ruptures, growth disturbances, and axial deviations. While the argument for avoiding growth malalignment does not seem to be a crucial point, the PS technique should be the preferred approach in a young population to ensure knee laxity restoration.

Level of evidence

Level III.

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Authors and Affiliations

  1. Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

    Gherardo Pagliazzi, Marco Cuzzolin, Luca Pacchiarini, Marco Delcogliano, Giuseppe Filardo & Christian Candrian

  2. Department of Paediatric Orthopaedics, University of Basel Children’s Hospital, Basel, Switzerland

    Gherardo Pagliazzi

  3. Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland

    Marco Delcogliano, Giuseppe Filardo & Christian Candrian

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LP, MC, and GF carried out the data-analysis. All authors participated in writing the article; all authors read and approved the final manuscript.

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Correspondence to Luca Pacchiarini.

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Pagliazzi, G., Cuzzolin, M., Pacchiarini, L. et al. Physeal-sparing ACL reconstruction provides better knee laxity restoration but similar clinical outcomes to partial transphyseal and complete transphyseal approaches in the pediatric population: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 31, 206–218 (2023). https://doi.org/10.1007/s00167-022-07032-0

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