2025 ISAKOS Biennial Congress ePoster
Physeal-Sparing ACL Reconstruction Has Equivalent Survivorship And Functional Outcomes As Transphyseal Reconstruction But Does Not Prevent Growth Disturbance: A Systematic Review Of Clinical And Radiological Outcomes
Muaaz Tahir, BSc, MBBS, FRCS (Tr & Orth), DFSEM(UK), Birmingham UNITED KINGDOM
Musab Al-Musabi, BSc, MBBS, FRCS, Birmingham UNITED KINGDOM
Tahir Khaleeq, MBBS, MRCSED, PG DIP MED ED UNITED KINGDOM
Omar Ezzat Saber Mostafa, MBChB, MRCSEd, PGCert, MAcadMEd, Birmingham, West Midlands UNITED KINGDOM
Stephen Dalgleish, MBChB, MRCS, FRCS, Dundee UNITED KINGDOM
Amit Meena, MBBS, MS, DNB, Jaipur, Rajasthan INDIA
Darren L. de SA, MD MBA FRCSC, Hamilton, Ontario CANADA
Peter D'Alessandro, MBBS (Hons), FAOrthA, FRACS, Claremont, WA AUSTRALIA
Nick Nicolaou UNITED KINGDOM
Shahbaz S. Malik, BSc, MB BCh, MSc (Orth Engin), LLM, FRCS (Tr&Orth), Birmingham UNITED KINGDOM
The Royal Orthopaedic Hospital, Birmingham, UNITED KINGDOM
FDA Status Cleared
Summary
Despite the controversy regarding the choice of ACL reconstruction techniques in the paediatric population, both transphyseal and physeal-sparing techniques produced good patient reported outcomes, with no significant differences in graft rupture rates. Patients who undergo physeal-sparing reconstruction are generally younger, thus more susceptible to growth-related complications post-surgery.
ePosters will be available shortly before Congress
Abstract
Background
ACL reconstruction in the paediatric population presents unique challenges, owing to the ongoing skeletal growth. This systematic review aimed to compare the functional and radiological outcomes of transphyseal(TP), partial transphyseal(pTP) and physeal-sparing(PS) techniques.
Methods
A systematic search of the MEDLINE and EMBASE databases was performed in accordance with the PRISMA guidelines to identify studies reporting growth disturbances and/or functional outcomes. Studies reporting on combined or hybrid/partial TP techniques were excluded. Leg length discrepancy (LLD) was defined as >10mm and angular deformity (AD) as >5° difference. Pooled incidence of growth disturbance and graft rupture was calculated from available raw data using an inverse-variance random-effects model. Studies were appraised using the Methodological Index for Non-Randomized Studies (MINORS) checklist with a maximum score of 16 for non-comparative studies and 24 for comparative studies.
Results
The search identified 37 studies reporting on TP (n=1384), 12 on PS (n=882), and 5 comparing both techniques (n=2098), with mean follow up ranging from 1.25 to 8 years. Mean age in the TP studies ranged from 12-16.4 years and in PS studies from 10.5-14.3 years. Pooled proportional incidence of leg length discrepancy was 1.3% in the TP and 3.4% in the PS studies. Incidence of angular deformities was 1.5% in TP studies and 1.8% in the PS studies. Graft rupture rate was 6% in the TP studies, compared to 8.1% in the PS studies. Mean Lysholm scores ranged from 84.6 - 98.8 in the TP and 93 - 100 in the PS studies. Mean IKDC scores ranged from 83.3 - 95.4 in the TP and 94 - 96.5 in the PS studies. Five comparative studies reported no differences in rates of graft rupture or growth disturbance. MINORS scores ranged from 8-12 for non-comparative and 16-20 for comparative studies.
Conclusion
Transphyseal and physeal-sparing ACL reconstruction techniques result in similar patient reported outcomes and graft rupture rates. Patients who undergo physeal-sparing reconstruction are generally younger, thus more susceptible to growth-related complications post-surgery. Larger comparative studies with age-matched cohorts are required to investigate this association further.