2015 ISAKOS Biennial Congress ePoster #1367

Transphyseal Pediatric ACL Reconstruction Causes Femoral Growth Disturbances. A Clinical and Radiographic Study in 33 Patients

Peter Faunoe, MD, Risskov DENMARK
Lone Rømer, MD, Aarhus DENMARK
Torsten Grønbech, Phys., Aarhus DENMARK
Martin Lind, MD, PhD, Prof., Aarhus N DENMARK
Dept Sports Traum, Aarhus University Hospital, Aarhus, DENMARK

FDA Status Not Applicable

Summary: ACL reconstruction in children result in detectable growth disturbances in 23% of patients

Abstract:

Background

There is no golden standard treatment for pediatric ACL ruptures. Conservative treatment is associated with secondary problems such as meniscal and cartilage lesions. Therefore operative treatment is generally recommended. Transphyseal ACL reconstruction techniques can cause growth disturbances. But the indications for pediatric ACL reconstruction as well as the risk of growth disturbances is poorly substantiated in the literature.

Methods

33 patients (girls 36%) with average age of 11.3 years at time of transphyseal ACL reconstruction were evaluated with full extremity radiographs for evaluation of leg length discrepancy and malalignment as well as clinical evaluation with KT1000 measurements, KOOS and Tegner scores after 68 (29-148) months follow-up.

Results

33 patients were evaluated clinically and radiologically. We found an average femoral length shortening of 3,6 mm (p=0.01) of operated leg. 8 patients (23%) had more than 10 mm shortening of the operated leg whereas 1 patient (3%) had 10 mm shortening of the non-operated leg. The anatomical femoral axis of the operated leg were found to be in more than 2 degrees of valgus compared to the non operated leg in 27 of 33 patients (82% P<0.001). Tibial growth and anatomical axis also changed (p=0.01). Furthermore we found the largest leg length discrepancy to occur in the group of patients operated at the age from 12 -14 years compared to patients younger than 12 years. At follow-up KOOS symptom score was 76,8, pain 85, ADL 91, sport 69 and QOL 67,9 for symptoms, pain, ADL, Sports, QOL respectively. Tegner and KOOS scores were significant lower among girls compared to boys. KT1000 improved from 5,2mm preoperatively to 1,6 mm at follow-up.

Conclusion

Transphyseal ACL reconstruction in children result in clinically relevant growth disturbance in 23% of patients. Femoral growth is mainly affected and growth disturbance is mainly seen when surgery is performed in the growth spurt at age 12-14 years. Otherwise transphyseal ACL reconstruction has satisfactory clinical outcome with good subjective outcome, function level and knee stability.