Primary Partial Transphyseal Anterior Cruciate Ligament Reconstruction in Children with Open Physes

Abstract

The incidence of anterior cruciate ligament (ACL) injuries in skeletally immature patients is increasing, with ACL reconstruction preferred as it has been shown to have chondroprotective benefits in this population. Due to concerns with growth disturbances following ACL reconstruction in skeletally immature patients, results of various physical-sparing, partial-transphyseal, or complete-transphyseal techniques have been explored. Currently, there is no consensus on the most effective ACL reconstruction technique in skeletally immature patients. Therefore, the purpose of this study was to report the outcomes of a partial-transphyseal, over-the-top (OTT) ACL reconstruction in a cohort of skeletally immature patients. All patients with radiographic evidence of open tibial and femoral physes that underwent primary ACL reconstruction using the partial-transphyseal OTT technique between 2009-2018 at a single tertiary-care institution were retrospectively reviewed. Patient demographics, physical examination findings, graft ruptures, return to sport, and Tegner activity levels were analyzed. Statistical significance was defined as p <0.05. Overall, 22 males and 2 females (25 knees) with a mean age of 13.0 years (Standard Deviation [SD], 1.7 years) were included in the study. The mean postoperative follow-up was 2.1 years (SD, 1.7 years). There were four cases of ACL graft rupture (16%). All patients successfully returned to unrestricted sport at an average time of 7.3 months. Preinjury and postoperative Tegner activity levels were documented in 22 knees, of which 21/22 (95%) returned to the same or higher level. There were no documented cases of clinically significant longitudinal or angular growth disturbance. Partial transphyseal ACL reconstruction using a transphyseal tibial tunnel and an extra-articular, OTT position on the femur in skeletally immature affords minimal risk of growth disturbance with a graft rupture rate of 16% and a 95% return to sport at the same or higher level.