Summary
ACL injuries in the pediatric and adolescent population have increased in the last years and the surgical treatment is becoming the treatment of choice to prevent meniscal and cartilage damage and also to allow a full participation to sports activities. The choice of the surgical technique is based on skeletal and sexual maturity , because the remaining growth potential must be considered
Abstract
Introduction
Anterior cruciate ligament (ACL) injuries in the pediatric and adolescent population have increased in the last years and the surgical treatment is becoming the treatment of choice to prevent meniscal and cartilage damage and also to allow a full participation to sports activities. The choice of the surgical technique for ACL reconstruction is based on skeletal maturity assessment and Tanner staging, because the remaining growth potential must be considered in patients with open physes. We recently described an original technique for physeal spring ACL reconstruction with autologous ST e G graft, over the top technique and extra-articular reconstruction. The purpose of the current study was to assess the preliminary results in a group of prepubescent children (Tanner 1 and 2) with open physes.
Methods
A total of 7 patients (8 knees) were operated between January 2022 to March 2024. All patients were graded as Tanner 1 and 2 with an age between 9 and 13 years at the time of surgery. All patients were involved in sport (soccer) at a competitive youth level. ACL reconstruction was performed with a physeal sparing technique using semitendinosus and gracilis tendon autograft. There were 5 associated meniscal lesions: 2 lateral meniscus longitudinal tears, 2 lateral meniscus posterior root tear, 1 ramp lesion. Data were prospectively collected and included physical examination, arthrometric evaluation, PROMs and bilateral standing X-ray at one year of follow-up.
Results
Seven male patients (8 knees) were included in the study, with a mean age of 11 years (range 9-13). The minimum follow-up was 12 months (range 12-36). No complications such as infection, arthrofibrosis and ACL failure were observed. Physical examination at final follow-up revealed a negative Lachman and pivot-shift test in all patients. Anteroposterior laxity measured with Lachmeter showed a side to side difference between 0-3 mm in 8/8 knees with a mean difference of -0.5 mm (±1.5 mm). Long standing Radiographic evaluation showed no significant difference (p<0.05) in the mean length between the operated limb and the contralateral (0.26 cm ± 0.7 cm (p=0.34); the mean difference in MPTA was -2.1° ± 1° (p=0.058), in LDFA -1.87° ± 2.45° (p=0.116) and in MAD 8.85 mm ± 6.4 mm (p=0.345). PROMS were: 95.34 for Pedi-IKDC, 92.85 for KOOS Child-Other Symptoms, 95.83 for KOOS Child-Pain, 100 for KOOS Child-Function in Daily Living, 92. 86 for the KOOS Child-Function in Sport and Recreation, 80.76 for the KOOS Child-Knee Related Quality of Life, 99.6 for the Lysholm Scale, and 9.33 (range, 9-10) for the Tegner Activity scale. All patients returned to sport-specific activities and soccer competition.
Conclusions
The described technique for physeal sparing ACL reconstruction with ST e G and extra-articular procedure showed promising results in terms of knee stability, functional outcomes and return to sport. Radiological evaluation showed no differences in LLD between the operated and non-operated limb. However this is a preliminary report and an higher number of patients and a longer follow-up are needed to better understand the failure rate and the effect of the procedure on remaining bony growth.