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Growth Disturbances Following Paediatric Anterior Cruciate Ligament Reconstruction: A Systematic Review
Vijay Patil1, Praveen Rajan1, Edward Hayter1
1Trauma and Orthopaedics, Basildon University Hospital, Basildon, GBR.
Insights
Paediatric anterior cruciate ligament (ACL) reconstruction can cause growth disturbances. Extraphyseal techniques minimize these risks, making ACL reconstruction safe and effective for children.
Area of Science:
- Orthopedic Surgery
- Pediatric Sports Medicine
- Biomedical Engineering
Background:
- Transphyseal anterior cruciate ligament (ACL) reconstruction in children poses risks of growth disturbances.
- Physeal-sparing techniques have emerged to mitigate these complications.
- Understanding risk factors for growth disturbances is crucial for optimizing pediatric ACL surgery.
Purpose of the Study:
- To investigate growth disturbances following pediatric ACL reconstruction.
- To identify risk factors associated with these growth disturbances.
- To compare the safety and efficacy of different surgical techniques.
Main Methods:
- Systematic literature review adhering to PRISMA guidelines.
- Searched PubMed, Scopus, and Web of Science for case series on pediatric ACL reconstruction.
- Extracted data on growth disturbances and graft failures from eligible studies.
Main Results:
- 70 growth disturbances (2.6%) reported in 2,693 reconstructions, including coronal plane deformities, limb length discrepancies, and tibial slope changes.
- Extraphyseal techniques showed the lowest incidence of growth disturbances and graft failures (7.8%).
- Specific surgical techniques correlated with particular types of growth disturbances.
Conclusions:
- Pediatric ACL reconstruction is safe and effective, with growth disturbances being infrequent.
- Extraphyseal tunneling is associated with the lowest risk of growth disturbances.
- Minimizing drill size, steep drilling angles, and avoiding physeal periphery can reduce risks with transphyseal techniques.
Abstract:
Growth disturbances after transphyseal paediatric anterior cruciate ligament (ACL) reconstruction have led to the development of physeal-sparing techniques. The aim of this study is to investigate growth disturbances following paediatric ACL reconstruction and identify associated risk factors. A systematic search on PubMed, Scopus and Web of Science databases was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify case series reporting paediatric ACL reconstructions. Of 518 articles, 78 met the inclusion criteria, and data related to growth disturbances and graft failures were extracted. A total of 2,693 paediatric ACL reconstructions resulted in 70 growth disturbances (2.6%): 17 were varus, 26 were valgus, 13 were shortening, 14 were lengthening and five patients had reduced tibial slope. Some patients showed deformities in more than one plane. Coronal plane deformities were seen more frequently with eccentric physeal arrest and lengthening with intraepiphyseal tunnelling. Shortening and reduced tibial slope were related to large central physeal arrest and anterior tibial physeal arrest, respectively. Sixty-two studies documented 166 graft failures in 2,120 reconstructions (7.8%). The extraphyseal technique was least likely to result in growth disturbances and graft failure. Paediatric ACL reconstruction is a safe and effective treatment of rupture. Growth disturbances are least likely following extraphyseal tunnelling, and those resulting from transphyseal techniques can be minimised by reducing drill size, drilling steep and avoiding the physeal periphery. The insertion of hardware, synthetic material, or a bone plug through the drilled physis should be avoided. There is a greater need for robust long-term data collection, such as national ligament registries, to standardise practice and evaluate the risk of growth disturbance and re-ruptures in this treatment.
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