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, Birmingham UNITED KINGDOM
Musab Al-Musabi, BSc, MBBS, FRCS, Birmingham UNITED KINGDOM
Tahir Khaleeq, MBBS, MRCSED, PG DIP MED ED UNITED KINGDOM
Stephen Dalgleish, MBChB, MRCS, FRCS, Dundee UNITED KINGDOM
Darren L. de SA, MD MBA FRCSC, Hamilton, Ontario CANADA
Peter D'Alessandro, MBBS Hons. (UWA) FRACS FAOrthA, 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.
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Abstract
Introduction
Anterior cruciate ligament reconstruction (ACLR) in the paediatric population presents unique challenges, owing to the ongoing growth of the skeletal system. This systematic review aimed to compare the functional and radiological outcomes of transphyseal (TP) and physeal-sparing (PS) techniques.
Methods
A review of the online databases Medline, Embase, and PubMed was conducted in August 2024, according to PRISMA guidelines. Clinical studies reporting functional outcomes and/or growth disturbance were included. 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. The incidence of growth disturbance and graft rupture was pooled from the available raw data for each technique. 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 strategy identified 36 studies reporting on TP (n=1318), 10 on PS (n=630), 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 incidence of LLD was 1% in the TP and 2.7% in the PS studies (p= 0.019). Incidence of AD was 1.8% in TP studies and 1.4% in the PS studies (p= 0.8). 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. Graft rupture rate in the TP studies was 7.7%, compared to 6% in the PS studies (p= 0.06). Four out of 5 comparative studies reported no significant differences in the incidence of graft rupture or growth disturbance between the two techniques whereas 1 study reported a higher incidence of residual laxity and AD with PS reconstructions. 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.