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ACL reconstruction in children: a transphyseal technique.

G Lemaitre1, E Salle de Chou1, V Pineau1

  • 1Niveau 11, INSERM U1075 COMETE « Mobilité : Attention, Orientation & Chronobiologie », Département de Chirurgie Orthopédique et Traumatologique, Université de Caen Basse-Normandie, Centre Hospitalier Universitaire de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.

Orthopaedics & Traumatology, Surgery & Research : OTSR
|April 9, 2014
PubMed
Summary

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Transphyseal anterior cruciate ligament (ACL) reconstruction using hamstring grafts effectively controls pediatric knee instability and preserves menisci. Strict adherence to technique minimizes risks like femoral epiphysiodesis.

Area of Science:

  • Orthopedic Surgery
  • Pediatric Sports Medicine
  • Knee Reconstruction

Background:

  • Increasing incidence of anterior cruciate ligament (ACL) tears in pediatric patients.
  • Chronic anterior instability leads to meniscal lesions, worsening with delayed surgery.
  • High failure rates associated with conservative therapy and extra-articular reconstructions.

Purpose of the Study:

  • Evaluate the efficacy and safety of a transphyseal technique for ACL reconstruction in skeletally immature patients.
  • Assess outcomes regarding knee stability, meniscal preservation, and functional recovery.
  • Identify potential complications, such as physeal closure.

Main Methods:

  • Transphyseal anterior cruciate ligament (ACL) reconstruction using hamstring tendon grafts in 14 knees (13 patients).
Keywords:
Anterior cruciate ligamentSkeletal immaturityTransphyseal technique

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  • Mean patient age: 13 years 7 months; mean injury-to-surgery interval: 6 months.
  • Strict adherence to technical guidelines: bone tunnel diameter ≤ 8 mm, vertical/central tunnels, appropriate fixation to avoid bridging the physis. Meniscal lesions treated conservatively.

    • Main Results:

    • Excellent or good functional outcomes in 93% of knees (IKDC grade A/B, high Lysholm scores).
    • No recurrent tears or revision meniscectomies at mean 15-month follow-up.
    • Two knees showed signs of femoral epiphysiodesis (4° valgus deformity), with no clinical impact.

    Conclusions:

    • Transphyseal ACL reconstruction is a viable option for pediatric patients with open physes, effectively managing instability and preserving menisci.
    • Strict adherence to surgical technique is crucial to minimize risks, particularly femoral epiphysiodesis.
    • This method offers good functional recovery and stability, though physeal complications warrant monitoring.