Purpose
To evaluate the effect of transphyseal anterior cruciate ligament (ACL) reconstruction
on lower extremity radiographic growth and alignment.
Methods
We retrospectively reviewed patients who underwent transphyseal ACL reconstruction
and were followed to skeletal maturity or at least 2 years, with the nonoperative
limb used as an internal control. Changes in coronal plane alignments and tibial slope
of the operative limb were compared with a Wilcoxon test. Associations among sex,
tunnel, and graft characteristics and failure; changes in coronal plane measures and
tunnel size; and tunnel angles and the development of deformity were examined by χ-square
and correlation coefficients.
Results
Fifty-nine patients (41 boys and 18 girls) underwent surgery at a mean age of 12.5 years
(range, 6.8-16.0 years). There were differences in changes in the mechanical lateral
distal femoral angle comparing operative and nonoperative limbs (decreased 1.1° in
girls and 1.9° in boys ≤13 years of age, P = .0008 and .025, respectively) and in changes in tibial slope of the operative limb
(decreased 2.1° in male patients >13 years, P = .012). No patient developed a new limb length difference >1 cm. Two boys were treated
for deformities. Eight additional patients developed >5° difference in alignment for
a rate of radiologic deformity of 10 of 59 or 17%. Neither graft failure nor the presence
of deformity was associated with sex, tunnel size, mode of femoral tunnel positioning,
inclination of tunnels, or the use of allograft.
Conclusions
Radiographically evident limb deformities following transphyseal ACL reconstruction
occurred at a rate of 17%, although these deformities were clinically evident in only
5% of patients. Tunnels intersecting physes near cortical margins may increase the
risk of developing deformity. Regular follow-up should include alignment radiographs
to detect deformities despite the clinical appearance of neutral limb alignment.
Level of Evidence
Level III, case-control study.
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Article info
Publication history
Published online: February 04, 2019
Accepted:
October 28,
2018
Received:
June 20,
2018
Footnotes
See commentary on page 950
The authors report the following potential conflicts of interest or sources of funding: This study was funded in part by the L.T. Staheli Endowment. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2018 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Mild Limb Asymmetry and Pediatric Anterior Cruciate Ligament Reconstruction—A Classic “Chicken and Egg” Scenario?ArthroscopyVol. 35Issue 3
- PreviewGrowth disturbance from a physeal injury is considered by many surgeons to be the most feared iatrogenic surgical complication after anterior cruciate ligament (ACL) reconstruction in skeletally immature patients, typically resulting in valgus, recurvatum, and/or a short limb. These deformities also predispose children to an ACL injury in the first instance, and therefore, a firm understanding of the contributions of both preoperative deformity and iatrogenic injury to postoperative limb asymmetry is critical.
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