Physeal-Sparing Intraarticular Anterior Cruciate Ligament Reconstruction in Preadolescents

Abstract

Background: In the very young patient in need of anterior cruciate ligament reconstruction, the option of reconstruction with physeal-sparing techniques is valid because it is not known what percentage of physeal transgression causes adverse growth consequences. Purpose: To report our experience with an intraarticular technique for anterior cruciate ligament reconstruction that spares the open femoral and tibial physes yet allows soft tissue graft fixation in the femoral and tibial tunnels. Methods: Eight preadolescents underwent physeal-sparing intraarticular reconstruction for anterior cruciate ligament insufficiency with the use of semitendinosus and gracilis tendon grafts. All eight patients were in Tanner stage 1 with an average chronologic age of 11.15 years and average bone age of 10.9 years. Preoperative prediction of lower limb growth averaged 10.8 cm. Results: Five of the eight patients had reached skeletal maturity at follow-up, which was at an average of 69.2 months postoperatively. For these five, the Orthopadische Arbeitsgruppe Knie (OAK) score averaged 97 and the average KT-2000 arthrometer difference was 1.8 mm. Average growth in total height from surgery to final follow-up was 21.7 cm. No patient had a leg-length discrepancy or angular deformity, as verified by clinical or teleroentgenogram measurements. Conclusions: The technique presented in this study provided graft isometry and stability without adverse physeal consequences. Additional research is needed to determine the threshold percentage of physeal transgression for avoiding growth disturbances in humans.