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Anterior Cruciate Ligament Reconstruction Using the Transphyseal Technique in Prepubescent Athletes: Midterm,
Marcin Domzalski1, Anna Karauda1, Andrzej Grzegorzewski1
1Department of Orthopaedics and Pediatric Orthopaedics, Medical University of Lodz, Lodz, Poland.
Purpose:
To evaluate the efficacy, results, and complications of transphyseal technique of anterior cruciate ligament (ACL) reconstruction in prepubertal patients and to assess a possible influence of children's growth on the outcome.
Methods:
Between 2005 and 2009, 22 (16 boys and 6 girls) prepubescent patients, Tanner stage 1 and 2, underwent ACL reconstruction and the follow-up 6, 12, and 24 months after surgery and after growth plate closure. The average age of the girls was 11.2 years, and of the boys, 12.3 years. The average follow-up period was 77.2 months. Clinical outcome was evaluated by Lysholm, Tegner, and International Knee Documentation Committee (IKDC) objective and subjective knee scores. Standard radiograms were performed for potential axial growing disturbance.
Results:
The average follow-up period was 77.2 months (range, 54 to 102 months), and IKDC subjective scores changed from 58 (range, 44 to 69) before surgery to 87 (range, 86 to 87; P = .00) at 6 months, 93 (range, 88 to 97; P = .00) at 12 months, and 95 (range, 92 to -98; P = .5) at final examination. Lysholm score increased from 58 (range, 53 to 64) before surgery to 89 (range, 85 to 92; P = .00) at 6 months and 96 (range, 94 to 100; P = .00) at 12 months, 24 months (P = .9), and final examination (P = .8). Before injury, all patients were graded 7 on the Tegner scale. Nineteen athletes reached at least grade 7 and returned to the level of activity a mean of 9 months after the surgery. No patient had deformity or growth disturbances observed clinically.
Conclusions:
Arthroscopic-assisted transphyseal ACL reconstruction in prepubescent patient is a promising technique, provided that all technical details are respected. It gives excellent subjective and objective knee scores and provides a very good function of the knee joint in the midterm period with no or only minor effect on the leg length. The rate of growth after surgery did not influence the results.
Level Of Evidence:
Level IV, therapeutic case series.
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