Abstract
Purpose
Our purpose was to evaluate the clinical and radiological outcome at maturity of an « adult-like » transphyseal anterior cruciate ligament (ACL) reconstruction performed in skeletally immature patients using four-strand hamstring graft.
Methods
The records of all skeletally immature patients who underwent transphyseal ACL reconstruction between 2004 and 2006 at our institution were reviewed. Inclusion criteria were age less than 16 years and radiographic evidence of open physes. Thirty-eight children and prepubescents were identified. All underwent postoperative clinical evaluation with International Knee Documentation Committee scores and long leg radiographs. Each patient was followed up until skeletal maturity was confirmed.
Results
Twenty-eight patients were scored A, four B, and five D according to IKDC. At last follow-up, there was no radiographic evidence of malalignment in any of the patients. Five underwent a reoperation. Three patients suffered traumatic graft disruption and two from post-operative knee instability.
Conclusion
Early operative treatment by means of the quadruple hamstring free graft appears to be a safe and relevant procedure for ACL reconstruction even in skeletally immature patients.
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References
Arbes S, Resinger C, Vecsei V, Nau T (2007) The functional outcome of total tears of the anterior cruciate ligament (ACL) in the skeletally immature patient. Int Orthop 31:471–475
Bales CP, Guettler JH, Moorman CT 3rd (2004) Anterior cruciate ligament injuries in children with open physes: evolving strategies of treatment. Am J Sports Med 32:1978–1985
Bisson LJ, Wickiewicz T, Levinson M, Warren R (1998) ACL reconstruction in children with open physes. Orthopedics 21:659–663
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 25:831–838
Gaulrapp HM, Haus J (2006) Intraarticular stabilization after anterior cruciate ligament tear in children and adolescents: results 6 years after surgery. Knee Surg Sports Traumatol Arthrosc 14:417–424
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
Henry J, Chotel F, Chouteau J, Fessy MH, Berard J, Moyen B (2009) Rupture of the anterior cruciate ligament in children: early reconstruction with open physes or delayed reconstruction to skeletal maturity? Knee Surg Sports Traumatol Arthrosc 17:748–755
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
Marx A, Siebold R, Sobau C, Saxler G, Ellermann A (2008) ACL reconstruction in skeletally immature patients. Z Orthop Unfall 146:715–719
McIntosh AL, Dahm DL, Stuart MJ (2006) Anterior cruciate ligament reconstruction in the skeletally immature patient. Arthroscopy 22:1325–1330
Meller R, Kendoff D, Hankemeier S, Jagodzinski M, Grotz M, Knobloch K, Krettek C (2008) Hindlimb growth after a transphyseal reconstruction of the anterior cruciate ligament: a study in skeletally immature sheep with wide-open physes. Am J Sports Med 36:2437–2443
Millett PJ, Willis AA, Warren RF (2002) Associated injuries in pediatric and adolescent anterior cruciate ligament tears: does a delay in treatment increase the risk of meniscal tear? Arthroscopy 18:955–959
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
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
Paley D, Tetsworth K (1992) Mechanical axis deviation of the lower limbs. Preoperative planning of multiapical frontal plane angular and bowing deformities of the femur and tibia. Clin Orthop Relat Res 280:65–71
Pressman AE, Letts RM, Jarvis JG (1997) Anterior cruciate ligament tears in children: an analysis of operative versus nonoperative treatment. J Pediatr Orthop 17:505–511
Schachter AK, Rokito AS (2007) ACL injuries in the skeletally immature patient. Orthopedics 30:365–370
Schneider FJ, Kraus T, Linhart WE (2008) Anterior cruciate ligament reconstruction with semitendinosus tendon in children. Oper Orthop Traumatol 20:409–422
Seil R, Pape D, Kohn D (2008) The risk of growth changes during transphyseal drilling in sheep with open physes. Arthroscopy 24:824–833
Shea KG, Apel PJ, Pfeiffer RP, Traughber PD (2007) The anatomy of the proximal tibia in pediatric and adolescent patients: implications for ACL reconstruction and prevention of physeal arrest. Knee Surg Sports Traumatol Arthrosc 15:320–327
Steadman JR, Cameron-Donaldson ML, Briggs KK, Rodkey WG (2006) A minimally invasive technique (“healing response”) to treat proximal ACL injuries in skeletally immature athletes. J Knee Surg 19:8–13
Utukuri MM, Somayaji HS, Khanduja V, Dowd GS, Hunt DM (2006) Update on paediatric ACL injuries. Knee 13:345–352
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Courvoisier, A., Grimaldi, M. & Plaweski, S. Good surgical outcome of transphyseal ACL reconstruction in skeletally immature patients using four-strand hamstring graft. Knee Surg Sports Traumatol Arthrosc 19, 588–591 (2011). https://doi.org/10.1007/s00167-010-1282-2
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DOI: https://doi.org/10.1007/s00167-010-1282-2