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Outcomes of physeal-sparing posterior cruciate ligament reconstruction for adolescents with an open physis

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Abstract

Purpose

The posterior cruciate ligament (PCL) rupture rarely occurs, especially in skeletally immature adolescents, and poses a dilemma in appropriately managing the open physis with its vast growth potential. However, although many epiphyseal-protecting techniques for anterior cruciate ligament (ACL) reconstruction have been reported, a similar problem in PCL reconstruction has received scant attention and needs more relevant research. So, this study aims to evaluate the short-term clinical and imaging results of the arthroscopic physeal-sparing reconstruction program.

Method

All the 13 patients we reviewed in this study have accepted the arthroscopic physeal-sparing PCL reconstruction from January 2019 to December 2022 in our Department of Orthopedics. Primary demographic data collected include gender (8 males and 5 females), age (11–15 years, average 13.3 years), follow-up period (15–35 months, average 25.2 months), injury mechanism (nine non-contact injuries and four contact injuries), and days following injury (1–10 days, average 5.3 days). The assessment of clinical outcomes included pre- and postoperative physical examination, knee functional scores, and imaging data.

Result

All patients in this study were followed up with an average 25.2-month (range 15–35 months) follow-up period. All the cases preoperatively had a positive posterior drawer test and turned negative at the final follow-up. The average ROM improved from 103.6° ± 11.4° to 132.6° ± 3.6° at the last follow-up (p < 0.05). The VAS score decreased from 5.8 ± 1.6 to 0.9 ± 0.5 (p < 0.05); the average KT-1000 healthy-side to affected-side difference decreased from 11.3 ± 1.6 to1.8 ± 0.5 mm. The comparison of all the knee functional scores (IKDC, Tegner scores, and Lysholm) at preoperative and last follow-up showed a significant difference (p < 0.05). None of the cases had operation-related complications, and all recovered to sports well.

Conclusion

The arthroscopic physeal-sparing posterior cruciate ligament reconstruction is a dependable and recommended treatment for posterior cruciate ligament rupture in adolescents with open physis, showing a striking improvement in knee function without growth arrest and angular deformity of the affected limb in the short-term follow-up.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to limitations of ethical approval involving the patient data and anonymity but are available from the corresponding author on a reasonable request.

Abbreviations

PCL :

Posterior cruciate ligament

ACL :

Anterior cruciate ligament

ACLR :

Arthroscopic anterior cruciate ligament reconstruction

PCLR :

Posterior cruciate ligament reconstruction

ROM :

Range of motion

VAS :

Visual analogue scale

IKDC :

International Knee Documentation Committee

MRI :

Magnetic resonance imaging

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Acknowledgements

We would like to thank all the staff in our Department of Orthopedics.

Funding

This work was financially supported by Sichuan Science and Technology Program (Grant No. 2023YFO0009) to Zhong Li.

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Author notes

  1. Xu Liu, Haibo Yang, and Zhong Jun contributed equally to this study.

Authors and Affiliations

  1. Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People’s Republic of China

    Xu Liu, Haibo Yang, Zhong Jun, Lingzhi Li, Zhaojun Wang, Zhong Li & Juncai Liu

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  1. Xu Liu
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  2. Haibo Yang
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  3. Zhong Jun
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Contributions

All authors contributed to the study conception and design. ZL and JL designed the study. XL drafted the article. ZL and JL performed the surgery. ZJ and HY revised the manuscript. LL and ZW collected the data. The authors read and approved the final manuscript.

Corresponding authors

Correspondence to Zhong Li or Juncai Liu.

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Ethics approval

The Ethics Committee of the Affiliated Hospital of Southwest Medical University approved all experimental procedures in conformity with the Declaration of Helsinki.

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Written informed consent was obtained from the parents.

Consent for publication

Informed consent for the article publication was obtained from all the patients and their parents in this study.

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The authors declare no competing interests.

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Liu, X., Yang, H., Jun, Z. et al. Outcomes of physeal-sparing posterior cruciate ligament reconstruction for adolescents with an open physis. International Orthopaedics (SICOT) (2023). https://doi.org/10.1007/s00264-023-06037-9

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