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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.
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).
- 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.
