TY - JOUR
T1 - Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients
T2 - Early Results Using a Hybrid Physeal-Sparing Technique
AU - Willson, Robert G.
AU - Kostyun, Regina O.
AU - Milewski, Matthew D.
AU - Nissen, Carl W.
N1 - Funding Information:
§Address correspondence to Carl W. Nissen, MD, Elite Sports Medicine, Connecticut Children’s Medical Center, 399 Farmington Avenue, Farmington, CT 06032, USA (email: cnissen@connecticutchildrens.org). *Department of Orthopaedic Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA. †Elite Sports Medicine, Connecticut Children’s Medical Center, Farmington, Connecticut, USA. ‡Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA. One or more of the authors has declared the following potential conflict of interest or source of funding: M.D.M. has received grant funding from the Pediatric Orthopaedic Society of North America, has received publishing royalties from Elsevier Inc, and receives research support from Vericel Corp and AlloSource Inc as a member of the Research in OsteoChondritis of the Knee (ROCK) group. C.W.N. has received unrestricted educational grants as a member of the ROCK group from Vericel Corp and AlloSource Inc. Ethical approval for this study was obtained from the Connecticut Children’s Medical Center (No. 14-109).
Publisher Copyright:
© 2018, © The Author(s) 2018.
PY - 2018/2/16
Y1 - 2018/2/16
N2 - Background: Reconstruction of the anterior cruciate ligament (ACL) in the skeletally immature patient is frequently performed in hopes of preventing new or additional chondral damage and meniscal injuries. Patients within a few years of skeletal maturity are more at risk for ACL injuries than prepubescent patients, about whom several physeal-sparing techniques have been described. Reconstruction techniques in the former higher risk group need to be better understood. Purpose: To review a series of adolescent patients with ACL injuries surgically treated with the hybrid physeal-sparing technique. Study Design: Case series; Level of evidence, 4. Methods: Surgical logs of ACL reconstructions (ACLRs) performed at a single pediatric/adolescent sports medicine center over a 6-year period were reviewed. Patients with open physes who had undergone ACLR with a femoral physeal-sparing tunnel and transphyseal tibial tunnel were identified. Their demographics, operative reports, rehabilitative course, time to return to play, outcome scores, and postoperative radiographs were collected and analyzed. Results: Twenty-three patients with a mean chronological age and bone age of 13.0 and 13.6 years, respectively, were identified. Examination and subjective outcome scores were obtained at a mean of 19 months and overall demonstrated positive results, with a mean Pediatric International Knee Documentation Committee (Pedi-IKDC) score of 96.0 and a mean Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) score of 89.1. Full-length mechanical axis films obtained at a mean 21 months postoperatively demonstrated no leg-length discrepancies or angular deformities in 21 of 23 patients. Two patients had an identified growth disturbance in the form of femoral and tibial growth acceleration on the ACL-reconstructed limb. Conclusion: The femoral physeal-sparing with transphyseal tibial drilling “hybrid” technique in skeletally maturing patients appears to have a high rate of success with low morbidity. However, the possibility of physeal abnormalities does exist, which demonstrates the importance of a close postoperative follow-up and evaluation until skeletal maturity is achieved. ACLR in skeletally immature patients is performed on an increasingly regular basis. Establishing the best and safest technique to do so is therefore important.
AB - Background: Reconstruction of the anterior cruciate ligament (ACL) in the skeletally immature patient is frequently performed in hopes of preventing new or additional chondral damage and meniscal injuries. Patients within a few years of skeletal maturity are more at risk for ACL injuries than prepubescent patients, about whom several physeal-sparing techniques have been described. Reconstruction techniques in the former higher risk group need to be better understood. Purpose: To review a series of adolescent patients with ACL injuries surgically treated with the hybrid physeal-sparing technique. Study Design: Case series; Level of evidence, 4. Methods: Surgical logs of ACL reconstructions (ACLRs) performed at a single pediatric/adolescent sports medicine center over a 6-year period were reviewed. Patients with open physes who had undergone ACLR with a femoral physeal-sparing tunnel and transphyseal tibial tunnel were identified. Their demographics, operative reports, rehabilitative course, time to return to play, outcome scores, and postoperative radiographs were collected and analyzed. Results: Twenty-three patients with a mean chronological age and bone age of 13.0 and 13.6 years, respectively, were identified. Examination and subjective outcome scores were obtained at a mean of 19 months and overall demonstrated positive results, with a mean Pediatric International Knee Documentation Committee (Pedi-IKDC) score of 96.0 and a mean Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) score of 89.1. Full-length mechanical axis films obtained at a mean 21 months postoperatively demonstrated no leg-length discrepancies or angular deformities in 21 of 23 patients. Two patients had an identified growth disturbance in the form of femoral and tibial growth acceleration on the ACL-reconstructed limb. Conclusion: The femoral physeal-sparing with transphyseal tibial drilling “hybrid” technique in skeletally maturing patients appears to have a high rate of success with low morbidity. However, the possibility of physeal abnormalities does exist, which demonstrates the importance of a close postoperative follow-up and evaluation until skeletal maturity is achieved. ACLR in skeletally immature patients is performed on an increasingly regular basis. Establishing the best and safest technique to do so is therefore important.
KW - anterior cruciate ligament reconstruction
KW - physeal sparing
KW - skeletally immature
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U2 - 10.1177/2325967118755330
DO - 10.1177/2325967118755330
M3 - Article
AN - SCOPUS:85042878068
SN - 2325-9671
VL - 6
JO - Orthopaedic Journal of Sports Medicine
JF - Orthopaedic Journal of Sports Medicine
IS - 2
ER -