Partial Trans-Physeal All-Inside Anterior Cruciate Ligament Reconstruction In Skeletally Immature Adolescent Patients: 2-Years Minimum Follow-Up Clinical And Radiographic Results

Partial Trans-Physeal All-Inside Anterior Cruciate Ligament Reconstruction In Skeletally Immature Adolescent Patients: 2-Years Minimum Follow-Up Clinical And Radiographic Results

Alessandro Carrozzo, MD, ITALY Edoardo Monaco, MD, ITALY Adnan Saithna, MD, FRCS, UNITED STATES Matteo Romano Cantagalli, MD, ITALY Nicola Carlo Bianco, MD, ITALY Serena Ciacio, MD, ITALY Alessandro Annibaldi, MD, ITALY Nicola Maffulli, MD, PhD, MS, FRCS(Orth), UNITED KINGDOM

La Sapienza University, Rome, ITALY


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Anatomic Location

Anatomic Structure

Diagnosis / Condition

Treatment / Technique

Ligaments

ACL

Patient Populations

Sports Medicine


Summary: Partial transphyseal all-inside ACL reconstruction in skeletally immature adolescents shows satisfactory clinical and radiographic results with low growth disturbances at 2-year follow-up.


Purpose

This study aimed to evaluate the efficacy and safety of a partial transphyseal all-inside Anterior cruciate ligament (ACL) reconstruction technique, hypothesizing that it would yield favorable clinical results without significant growth failure or secondary complications at a two-year follow-up.

Methods

Consecutive patients aged between 10 and 18 undergoing ACL reconstruction in a single institution from January 2015 to June 2021 were enrolled. Exclusion criteria were closed physes, prior knee surgeries, and multi-ligament injuries. The partial transphyseal all-inside technique was used, aiming to minimize the physeal damage. Standardized follow-ups were conducted at set intervals, with clinical and radiographic evaluations performed with a minimum 2 years follow-up.

Results

Overall, 24 patients met inclusion criteria, with a mean age of 14.2 years. At a mean follow-up of 53.1 months, the graft rupture rate was 12.5%, and the contralateral ACL rupture rate was 8.3%. Overall, the incidence of growth disturbances was 15.8% in patients who underwent radiographic evaluation. The mean limb length discrepancy was 0.31 cm and no significant differences in limb alignment. MRI analysis revealed a mean tibial tunnel widening of 5.1%, and graft maturity was graded I in 50% of patients and II in the remaining 50%. PROMs showed high scores for KOOS, IKDC, and Lysholm scales, with all patients returning to sport.

Conclusion

Partial transphyseal all-inside ACL reconstruction in skeletally immature patients demonstrated promising clinical outcomes and a low rate of significant growth disturbances, suggesting that it is an effective and safe technique for this population.