Anderson, J Bone Joint Surg Am 2003 - Transepiphyseal Replacement of the Anterior Cruciate Ligament in Skeletally Immature Patients

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Transepiphyseal Replacement of the Anterior Cruciate Ligament in Skeletally Immature Patients

Anderson·J Bone Joint Surg Am·2003·290 citations·Case series

Background

Fear of iatrogenic growth disturbance has prevented the routine use, in children, of anatomic methods of anterior cruciate ligament replacement that have proven successful in adults. To minimize the risk of growth disturbance, extra-articular or modified physeal sparing procedures have been performed to stabilize the knee, but these procedures do not provide isometry. This study was performed to evaluate the results of a transepiphyseal replacement of the anterior cruciate ligament in skeletally immature athletes.

Methods

From 1993 to 1999, 12 patients with a mean age (and standard deviation) of 13.3 +/- 1.4 years underwent replacement of the anterior cruciate ligament with a quadruple hamstring tendon graft performed with an arthroscopic technique and intraoperative fluoroscopic imaging for precise tunnel placement.
The femoral and tibial tunnels went through the epiphyses but avoided the physes.
8 of the 12 patients also had a meniscal repair.
All patients returned for follow-up, at a mean of 4.1 +/- 1.9 years (range, 2 to 8.2 years) after surgery.

Results

The mean amount of growth from the time of surgery to the time of follow-up was 16.5 +/- 10.0 cm (range, 8 to 38 cm).
The difference between the lengths of the lower limbs, as measured on orthoradiographs, was not clinically relevant.
The mean score on the International Knee Documentation Committee (IKDC) subjective knee form was 96.5 +/- 4.4 points (range, 86 to 100 points).
Ligament laxity testing with a KT-1000 arthrometer revealed a mean side-to-side difference of 1.5 +/- 1.1 mm.
The rating according to the criteria of the objective 2001 IKDC knee form was normal for seven patients and nearly normal for five.

Conclusions

Transepiphyseal replacement of the anterior cruciate ligament, a technically demanding procedure with a small margin of error, should be attempted only by accomplished knee surgeons. The preliminary results in this small series, however, demonstrate that this surgical technique can be performed in prepubescent patients with efficacy and relative safety.

Copyright remains with the authors and publisher.

Transepiphyseal Replacement of the Anterior Cruciate Ligament in Skeletally Immature Patients

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Transepiphyseal Replacement of the Anterior Cruciate Ligament in Skeletally Immature Patients

Anderson·J Bone Joint Surg Am·2003·290 citations·Case series

Background

Fear of iatrogenic growth disturbance has prevented the routine use, in children, of anatomic methods of anterior cruciate ligament replacement that have proven successful in adults. To minimize the risk of growth disturbance, extra-articular or modified physeal sparing procedures have been performed to stabilize the knee, but these procedures do not provide isometry. This study was performed to evaluate the results of a transepiphyseal replacement of the anterior cruciate ligament in skeletally immature athletes.

Methods

From 1993 to 1999, 12 patients with a mean age (and standard deviation) of 13.3 +/- 1.4 years underwent replacement of the anterior cruciate ligament with a quadruple hamstring tendon graft performed with an arthroscopic technique and intraoperative fluoroscopic imaging for precise tunnel placement.
The femoral and tibial tunnels went through the epiphyses but avoided the physes.
8 of the 12 patients also had a meniscal repair.
All patients returned for follow-up, at a mean of 4.1 +/- 1.9 years (range, 2 to 8.2 years) after surgery.

Results

The mean amount of growth from the time of surgery to the time of follow-up was 16.5 +/- 10.0 cm (range, 8 to 38 cm).
The difference between the lengths of the lower limbs, as measured on orthoradiographs, was not clinically relevant.
The mean score on the International Knee Documentation Committee (IKDC) subjective knee form was 96.5 +/- 4.4 points (range, 86 to 100 points).
Ligament laxity testing with a KT-1000 arthrometer revealed a mean side-to-side difference of 1.5 +/- 1.1 mm.
The rating according to the criteria of the objective 2001 IKDC knee form was normal for seven patients and nearly normal for five.

Conclusions

Transepiphyseal replacement of the anterior cruciate ligament, a technically demanding procedure with a small margin of error, should be attempted only by accomplished knee surgeons. The preliminary results in this small series, however, demonstrate that this surgical technique can be performed in prepubescent patients with efficacy and relative safety.

Copyright remains with the authors and publisher.

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