Summary

Twenty-two adolescents with open physes underwent anatomical transphyseal double-bundle ACL reconstruction (median follow-up, 45.2 months). At latest follow up, mean IKDC and Lysholm scores were 96.8±3.7 and 99.8±1.1. There was no graft failure case and no cases with significant angular deformity or limb-length discrepancy. Our procedures showed excellent outcomes.

Abstract

Background

Currently, we are performing anatomical transphyseal double-bundle ACL reconstruction with semitendinosus and gracilis autograft for adolescents aged 13 years or over with open physes. However, the outcomes and complications following transphyseal anterior cruciate ligament reconstruction with this double-bundle technique remain unclear. This study aimed to report the outcomes and complications of our procedure, including growth disturbances.

Materials And Methods

We performed a retrospective analysis of our database from January 2010 to August 2016. Twenty-two knees in 22 adolescents with open physes observed by T2-weighted MRI and radiograph (13-16 years, median 14.2) had undergone anatomical transphyseal double-bundle primary ACL reconstruction in our hospital during this period. Ten males and 12 females were evaluated. International Knee Documentation Committee (IKDC) and Lysholm scores were obtained preoperatively and at the time of the final evaluation. Physical examination, surgery details, changes in patient height, return to sports, anteroposterior knee laxity assessed by arthrometry, graft failures and contralateral ACL tears were evaluated. The angles of lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), intercondylar roof angle (IRA) and posterior tibial slope (PTS) and lower limb length were evaluated by radiographs at the latest follow up. Paired t-test was used for statistical analyses. P values <0.05 were considered statistically significant.

Results

The mean duration of follow-up was 45.2 months (range, 24-103 months). All patients had attained skeletal maturity at the time of ?nal follow-up. Surgery details demonstrated that mean diameters of the bone tunnels were 7.2mm (range, 6mm to 8.5mm) and 5.8mm (range, 5.5mm to 6.5mm) for the AM and PL bundles, respectively. The mean difference in patient height between the time of surgery and final follow up was 4.9±1.8cm (range, 3cm to 8cm). The average preoperative scores of the IKDC and Lysholm were 63.4±10.5 and 74.4±12.4 respectively. At the final follow-up, both scales significantly improved to 96.8±3.7 and 99.8±1.1, respectively (P <0.001). All patients could return to active sports, with five of 22 patients returning at a lower activity level. Arthrometry was performed in all patients. The average preoperative difference with respect to the healthy knee was 4.5±1.4mm (range, 3 to 8 mm), with significant improvement to 0.9±1.4mm (P <0.001) at final follow-up. There was no graft failure and four (18.2%) contralateral ACL tear cases. At the final follow-up, there were no cases with significant angular deformity or limb-length discrepancy as the mean side to side differences of LDFA, MPTA, IRA and PTS, and lower limb length were -0.09±0.29°, -0.09±0.29°, -0.09±0.43°and -0.05±0.38°, 0.0±0.0cm respectively (P>0.05).

Conclusions

Our anatomical transphyseal double-bundle ACL reconstruction in skeletally immature adolescents was associated with excellent outcomes and low failure rate without growth disturbance as compared with other previous studies using other techniques including the single-bundle technique.