Kocher, J Bone Joint Surg Am 2007 - Transphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Pubescent Adolescents

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Transphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Pubescent Adolescents

Kocher, Micheli, et al.·J Bone Joint Surg Am·2007·266 citations·Case series

Background

Management of anterior cruciate ligament injuries in skeletally immature patients is controversial. Conventional surgical reconstruction techniques for adults can cause iatrogenic growth disturbance due to physeal damage in children. The purpose of this study was to evaluate the results of a transphyseal reconstruction technique in pubescent but skeletally immature adolescents.

Methods

Between 1996 and 2004, 61 knees in 59 skeletally immature pubescent adolescents (Tanner stage 3) with a mean chronological age of 14.7 years (range, 11.6 to 16.9 years) underwent transphyseal reconstruction of the anterior cruciate ligament with use of an autogenous quadrupled hamstrings-tendon graft and metaphyseal fixation.
31 knees had additional meniscal surgery.
The functional outcome, graft survival, radiographic outcome, and any growth disturbance were evaluated at a mean of 3.6 years (range, 2.0 to 10.2 years) after the surgery.

Results

2 patients (3%) underwent revision anterior cruciate ligament reconstruction because of graft failure at 14 and 21 months postoperatively.
For the remaining 59 knees, the mean International Knee Documentation Committee subjective knee score (and standard deviation) was 89.5 +/- 10.2 points and the mean Lysholm knee score was 91.2 +/- 10.7 points.
The result of the Lachman examination was normal in 51 knees and nearly normal in 8; it was not abnormal or severely abnormal in any knee.
The result of the pivot-shift examination was normal in 56 knees and nearly normal in 3 knees; it also was not abnormal or severely abnormal in any knee.
The mean increase in total height was 8.2 cm (range, 1.2 to 25.4 cm) from the time of surgery to the time of final follow-up.
No angular deformities of the lower extremity were measured radiographically, and no lower-extremity length discrepancies were measured clinically.
Complications included 3 cases of arthrofibrosis requiring manipulation with the patient under anesthesia.

Conclusions

Transphyseal reconstruction of the anterior cruciate ligament with use of an autogenous quadrupled hamstrings-tendon graft with metaphyseal fixation in skeletally immature pubescent adolescents provides an excellent functional outcome with a low revision rate and a minimal risk of growth disturbance.

Copyright remains with the authors and publisher.

Transphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Pubescent Adolescents

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Transphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Pubescent Adolescents

Kocher, Micheli, et al.·J Bone Joint Surg Am·2007·266 citations·Case series

Background

Management of anterior cruciate ligament injuries in skeletally immature patients is controversial. Conventional surgical reconstruction techniques for adults can cause iatrogenic growth disturbance due to physeal damage in children. The purpose of this study was to evaluate the results of a transphyseal reconstruction technique in pubescent but skeletally immature adolescents.

Methods

Between 1996 and 2004, 61 knees in 59 skeletally immature pubescent adolescents (Tanner stage 3) with a mean chronological age of 14.7 years (range, 11.6 to 16.9 years) underwent transphyseal reconstruction of the anterior cruciate ligament with use of an autogenous quadrupled hamstrings-tendon graft and metaphyseal fixation.
31 knees had additional meniscal surgery.
The functional outcome, graft survival, radiographic outcome, and any growth disturbance were evaluated at a mean of 3.6 years (range, 2.0 to 10.2 years) after the surgery.

Results

2 patients (3%) underwent revision anterior cruciate ligament reconstruction because of graft failure at 14 and 21 months postoperatively.
For the remaining 59 knees, the mean International Knee Documentation Committee subjective knee score (and standard deviation) was 89.5 +/- 10.2 points and the mean Lysholm knee score was 91.2 +/- 10.7 points.
The result of the Lachman examination was normal in 51 knees and nearly normal in 8; it was not abnormal or severely abnormal in any knee.
The result of the pivot-shift examination was normal in 56 knees and nearly normal in 3 knees; it also was not abnormal or severely abnormal in any knee.
The mean increase in total height was 8.2 cm (range, 1.2 to 25.4 cm) from the time of surgery to the time of final follow-up.
No angular deformities of the lower extremity were measured radiographically, and no lower-extremity length discrepancies were measured clinically.
Complications included 3 cases of arthrofibrosis requiring manipulation with the patient under anesthesia.

Conclusions

Transphyseal reconstruction of the anterior cruciate ligament with use of an autogenous quadrupled hamstrings-tendon graft with metaphyseal fixation in skeletally immature pubescent adolescents provides an excellent functional outcome with a low revision rate and a minimal risk of growth disturbance.

Copyright remains with the authors and publisher.

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