2021 ISAKOS Biennial Congress ePoster
Transphyseal Anterior Cruciate Ligament Reconstruction In Skeletally Immature Patients
Matthew Howell, FRCS, MBChB, BMSc, PGCert, Glasgow UNITED KINGDOM
Michael Brown, MBChB UNITED KINGDOM
Ting Yang Tan, MBChB, MRCS(Glas), Glasgow, Scotland UNITED KINGDOM
Quintin Liao, MBCHB, MRCS UNITED KINGDOM
Christopher Gee, MBChB, MSc, FRCSEd(Tr&Orth), MFSTEd, Glasgow UNITED KINGDOM
NHS Greater Glasgow & Clyde, Glasgow, UNITED KINGDOM
FDA Status Cleared
Summary
Complication rates following transphyseal ACL reconstruction are low, even in Tanner I or II patients, however further comparative studies are needed to provide a full understanding on the efficacy of differing surgical techniques.
ePosters will be available shortly before Congress
Abstract
Aims
The incidence and surgical management of anterior cruciate ligament (ACL) injuries in skeletally immature patients is increasing. Risk of growth disturbance from physeal injury due to growth plate injury remains a concern for transphyseal techniques. This systematic review aims to collaborate data published for the outcomes and complications from transphyseal techniques in this patient group.
Methods
A systematic review of the literature was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A comprehensive search of Medline, Embase, Ovid, PubMed, Cochrane, and Google scholar databases was performed using search terms: “ACL”, “anterior cruciate ligament”, “paediatric”, “pediatric”, “immature”, “young”, “children, “child”.
Results
38 articles met the inclusion criteria and were included for analysis including 1323 cases. Risks included growth arrest in 0.73%, leg length discrepancy (LLD) >1cm in 2.05%, angular deformity >5° in 1.26%, and re-rupture in 7.11%. Six articles focussed purely on Tanner I or II patients with a total of 83 cases. No patients in this cohort had a LLD >1cm and only 1 case (1.52%) had an angular deformity >5°. The risk of re-rupture in this younger group was 4.82%. Overall 88% of cases reported a full return to sport, with average IKDC and Lysholm outcome scores of over 90.
Conclusion
This systematic review demonstrates that the risk of growth disturbance following transphyseal ACL reconstruction is rare, even in Tanner I and II patients. Transphyseal ACL reconstruction is an acceptable option for the paediatric population and provides acceptable clinical outcomes. However, there is a limit in comparative studies, and further randomised controlled trials are needed to provide a full understanding on the efficacy of differing surgical techniques.