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Pediatric Anterior Cruciate Ligament Reconstruction: A Systematic Review of Transphyseal Versus Physeal-Sparing
Todd P Pierce1, Kimona Issa1, Anthony Festa1
1Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey, USA.
Insights
Anterior cruciate ligament reconstruction in skeletally immature patients shows similar growth disturbance and graft survival rates between transphyseal and physeal-sparing techniques. Younger males are more likely to receive physeal-sparing surgery, with further research needed on long-term outcomes.
Area of Science:
- Orthopedic surgery
- Pediatric sports medicine
Background:
- Anterior cruciate ligament (ACL) reconstruction is increasingly performed in skeletally immature individuals.
- Both transphyseal and physeal-sparing surgical techniques are utilized.
- A systematic evaluation of pooled data is needed to compare these techniques.
Purpose of the Study:
- To compare demographics and outcomes of transphyseal versus physeal-sparing ACL reconstruction techniques in pediatric patients.
- To assess differences in growth disturbances and graft survivorship between the two techniques.
Main Methods:
- Systematic review of 3 databases.
- Identification and analysis of 43 reports, with 27 studies included (21 transphyseal, 6 physeal-sparing).
- Evaluation of demographic data, leg-length discrepancies, angular deformities, and graft survivorship.
Main Results:
- Transphyseal reconstruction was more common in females (39% vs 20%), while physeal-sparing was used in younger patients (12 vs 13.5 years).
- Similar incidence rates of leg-length discrepancies (0.81% vs 1.2%) and angular deformities (0.61% vs 0%) were observed.
- Graft rerupture rates were comparable between transphyseal (6.2%) and physeal-sparing (3.1%) cohorts.
Conclusions:
- Despite potential demographic differences, transphyseal and physeal-sparing ACL reconstruction techniques show no significant differences in growth disturbances or graft survivorship.
- Younger male patients tend to undergo physeal-sparing reconstruction.
- Further research is recommended to investigate long-term outcomes of physeal-sparing techniques due to limited existing data.
Background:
Anterior cruciate ligament reconstruction is becoming more common in skeletally immature individuals, and it may be performed with transphyseal or physeal-sparing techniques. A number of studies have assessed the outcomes of these techniques, but there is a need to systematically evaluate the pooled data from these studies.
Purpose:
To compare the differences in demographics and outcomes of transphyseal and physeal-sparing techniques by assessing (1) demographics, (2) incidence of growth disturbances, and (3) graft survivorship in the pediatric population.
Study Design:
Systematic review.
Methods:
A thorough review of 3 databases was performed to identify all studies that evaluated outcomes after pediatric reconstruction based on transphyseal or physeal-sparing techniques. After completing our search and cross-referencing for additional sources, 43 reports were identified for this review. Reports were analyzed for differences in demographics as well as incidence of leg-length discrepancies, angular deformities, and graft survivorship. After review of manuscripts, 27 studies were included for review (21 transphyseal and 6 physeal-sparing studies).
Results:
Those who had transphyseal reconstruction were more likely to be female (39% vs 20%; P = .0001), while those with the physeal-sparing surgery were younger (12 vs 13.5 years of age; P = .0001). The transphyseal and physeal-sparing cohorts demonstrated similar incidence rates of leg-length discrepancies (0.81% vs 1.2%, respectively; P = .64) and angular deformities (0.61% vs 0%, respectively; P = .36). The transphyseal and physeal-sparing cohorts also showed similar rates of rerupture (6.2% vs 3.1%, respectively; P = .11).
Conclusion:
Although the study groups were not well matched with regard to age and sex, our results show that these surgical techniques have no differences in incidence of growth disturbances or graft survivorship. Younger males tend to undergo physeal-sparing reconstruction. Future research should focus on long-term outcome metrics with the physeal-sparing techniques, as there remains a paucity of studies regarding them.
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