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Arthroscopy. 2009 Aug;25(8):831-8. doi: 10.1016/j.arthro.2009.01.015.

Transphyseal anterior cruciate ligament reconstruction in patients with open physes.

Author information

1
Orthopedic Sports Medicine Division, Department of Orthopaedic Surgery and Traumatology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil. m.cohen@uol.com.br

Abstract

PURPOSE:

The purpose of this study was to evaluate the clinical outcomes of transphyseal anterior cruciate ligament (ACL) reconstruction in patients with open physes.

METHODS:

Transphyseal ACL reconstruction was performed in 26 patients with open tibial and femoral physes (physis >2 mm) by use of autogenous quadrupled hamstrings as grafts. Meniscal tearing was found in 65.3% of the patients. Partial chondral defect injury on the medial femoral condyle was found 6 months after injury in only 2 patients (7.69% of all patients). The mean follow-up period was 45 +/- 18.3 months. Clinical outcomes were evaluated by use of the International Knee Documentation Committee score and Lysholm Knee Scoring Scale, and the anteroposterior stability was objectively measured by use of KT-1000 arthrometer (MEDmetric, San Diego, CA). Possible length and angular discrepancies were observed by conventional radiography in a long film and scanograms of the lower limbs.

RESULTS:

The mean length discrepancy between the operated lower limb and the contralateral limb was 1.2 +/- 3.2 mm (range, -7 to 7 mm). The mean angular deviation difference between the lower limbs was 0.46 degrees +/- 1.1 degrees . New traumatic injuries developed in 3 patients, in whom surgical revision was performed; 1 patient underwent a late meniscectomy. The mean difference in KT-1000 measurement was 2.0 +/- 1.0 mm. The mean subjective International Knee Documentation Committee score was 91.5 +/- 5.7, and the mean score on the modified Lysholm scale was 93.5 +/- 4. Of the patients, 3 (11.2% of all patients) could not return to the same level of physical activity as before injury.

CONCLUSIONS:

ACL reconstruction by use of the transphyseal technique in an immature skeleton with a hamstring autograft, with careful attention being paid to the technique, resulted in good clinical outcomes and no growth abnormalities.

LEVEL OF EVIDENCE:

Level IV, therapeutic case series.

PMID:
19664501
DOI:
10.1016/j.arthro.2009.01.015
[Indexed for MEDLINE]

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