Anterior cruciate ligament reconstruction in skeletally immature patients with transphyseal tunnels

Lauren H Redler, Rebecca T Brafman, Natasha Trentacosta, Christopher S Ahmad
Arthroscopy 2012, 28 (11): 1710-7

PURPOSE: Our purpose was to evaluate the results of transphyseal anterior cruciate ligament (ACL) reconstruction with hamstring autograft in skeletally immature patients.

METHODS: Eighteen knees in 18 skeletally immature pubescent patients with a mean chronologic age of 14.2 years underwent transphyseal ACL reconstruction with hamstring autograft between 2002 and 2007. Concurrent meniscal surgery was performed in 9 knees. The final patient evaluation occurred at a mean of 43.4 months (range, 24.0 to 86.6 months) and included physical examination, KT-1000 arthrometry testing (MEDmetric, San Diego, CA), and functional outcome instruments, including the International Knee Documentation Committee subjective knee form, the Lysholm knee score, and the Tegner knee activity scale.

RESULTS: At the latest follow-up, the mean International Knee Documentation Committee subjective knee score was 92.4 ± 10, the mean Lysholm knee score was 94.3 ± 8.8, and the mean Tegner activity scale score was 8.5 ± 1.4. Lachman and pivot-shift testing were negative in all knees. No restriction in knee range of motion of 5° or greater when compared with the contralateral knee was observed in any patient. The mean manual maximum side-to-side difference with KT-1000 testing was 0.29 ± 1.07 mm, and no patients had a difference greater than 3 mm. No angular deformities were noted, and all leg-length measurements were symmetric bilaterally on clinical examination. No patients had traumatic graft disruption or underwent revision ACL reconstruction, whereas 3 patients sustained an ACL injury in the contralateral leg while participating in sports.

CONCLUSIONS: Transphyseal ACL reconstruction with autogenous quadrupled hamstring graft with metaphyseal fixation in skeletally immature pubescent patients yielded excellent functional outcomes in a high percentage of patients without perceived clinical growth disturbance.

LEVEL OF EVIDENCE: Level IV, therapeutic case series.

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