Summary
Results after Hybrid physeal sparing Technique in pediatric ACL Reconstruction
Abstract
Peter Faunø, Torsten Grønbech Nielsen, Jannie Bøge Larsen, Michel Bach Hellfritzsch, Mette Mølby Nielsen, Martin Lind
Background
Anterior Cruciate Ligament Reconstruction (ACLR) in skeletally immature patients can result in growth plate injury, which may cause growth disturbances
Purpose
To evaluate radiological tibial and femoral length and axis growth disturbances as well as clinical outcome in skeletal immature Anterior Cruciate Ligament reconstruction (ACLr) patients treated with a femoral growth plate sparing ACLr technique.
Methods
Skeletal immature patients operated in the period 2013-2019 with ACLr using femoral growth plate sparing technique, were investigated with follow-up after growth plate closure. The inclusion criteria were isolated ACL rupture in patients with open physis in both distal femur and proximal tibia seen at plain x-ray. The minimum follow-up time was 29 months.
Patients were evaluated with full extremity radiographs measuring limb length discrepancy and coronal knee alignment compared to contralateral leg as well as clinical evaluation with Rolimeter measurements and KOOS, IKDC and Tegner Activity Scale scores.
Results
Sixty-five patients were examined with X-ray and 52 patients were assessed with clinical examination. No limb-length discrepancy (-0.65mm (CI: -2.21; 0.92)) or angular deformity at tibia (-0.25 degree (CI: -0.78; 0.28)) was found. There was a small but statistically significant different angular deformity at distal femur compared to contralateral leg (-1.51 degree (CI: -2.31; -0.72)) at follow-up.
The side-to-side difference in knee laxity at follow-up was 2.4 mm. At follow-up the KOOS sport, KOOS QoL, IKDC and Tegner was 80, 75, 86 and 5, respectively. Sixty seven percent of the patients met the Patients Acceptable Symptom State (PASS) and 52% reported the results exceeding KOOS Sport MCID Level and 69% the KOOSQoL level.
Conclusion
Femoral physis sparing ACLr is associated with low risk of alignment and length disturbances. The technique provides otherwise acceptable subjective clinical outcome and knee stability. In the light of the risk of delaying an ACL reconstruction with the well-reported risk of meniscal and articular cartilage damage the technique can be recommended for skeletal immature ACL injured patients.