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Abstract Presented at the 29th Annual Meeting of the Arthroscopy Association of North America| Volume 26, ISSUE 6, SUPPLEMENT , e21, June 01, 2010

Outcomes after Transphyseal Anterior Cruciate Ligament Reconstruction in Patients with Open Growth Plates (SS-42)

      Introduction

      Concerns about growth disturbance after transphyseal ACL reconstruction in the presence of open growth plates exist. The hypothesis was that transphyseal soft tissue ACL reconstruction in individuals with open growth plates would result in minimal risk for growth disturbance.

      Methods

      Between 5/03 and 10/07, 30 skeletally immature individuals with a mean age of 13.9 years (range 9 - 15 years) underwent ACL reconstruction with soft tissue grafts (22 hamstring autograft, 8 tibialis anterior allograft) using extraphyseal fixation. 22 knees had wide open growth plates and 8 knees had partially open growth plates. Outcomes were prospectively evaluated with KT-1000 measurements, IKDC, Cincinnati, and Lysholm scoring. Radiographs were evaluated for asymmetric physeal closure, growth arrest lines, and knee alignment, and patients were also clinically evaluated for limb alignment and leg length inequality at minimum 2 year follow-up.

      Results

      The mean knee scoring was 93.8 pts (IKDC), 97.0 pts (Cincinnati), and 92.4 pts (Lysholm) at 3.2 years mean follow-up (range, 1 - 6 years). The mean KT-1000 side to side difference at most recent follow-up was 0.77 mm. Minimum two-year radiographic and clinic evaluation revealed three Harris growth arrest lines, no asymmetric physeal closure, and a mean side to side difference of 1.4 degrees for radiographic tibiofemoral angle, and 0.3cm leg length inequality. Three patients sustained a graft re-rupture (10.0%).

      Conclusion

      Transphyseal ACL reconstruction with soft tissue grafts and extraphyseal fixation in patients with open growth plates resulted in good to excellent outcomes in 90% without evidence for clinically significant growth abnormalities.