Outcomes Following Primary Anterior Cruciate Ligament Reconstruction Using a Partial Transphyseal (Over-the-Top) Technique in Skeletally Immature Patients

Alan G Shamrock; Kyle R Duchman; William T Cates; Robert A Cates; Zain M Khazi; Robert W Westermann; Matthew J Bollier; Brian R Wolf

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Outcomes Following Primary Anterior Cruciate Ligament Reconstruction Using a Partial Transphyseal (Over-the-Top) Technique in Skeletally Immature Patients

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Outcomes Following Primary Anterior Cruciate Ligament Reconstruction Using a Partial Transphyseal (Over-the-Top) Technique in Skeletally Immature Patients

Alan G Shamrock, Kyle R Duchman, William T Cates, Robert A Cates, Zain M Khazi, Robert W Westermann, Matthew J Bollier and Brian R Wolf

The Iowa orthopaedic journal, Vol.42(1), pp.179-186

06/01/2022

PMCID: PMC9210405

PMID: 35821916

Appears in Diamond Open Access

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210405/View

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Abstract

BackgroundThe incidence of anterior cruciate ligament (ACL) injuries in skeletally immature patients is increasing, with ACL reconstruction preferred in this population due to reported chondroprotective benefits. Due to concerns with growth disturbance following ACL reconstruction in skeletally immature patients, various physealsparing and partial transphyseal techniques have been developed. Currently, there is no consensus on the most effective ACL reconstruction technique in skeletally immature patients. The purpose of the current study was to report the outcomes of a partial-transphyseal over-the-top (OTT) ACL reconstruction in a cohort of skeletally immature patients. MethodsAll patients with radiographic evidence of open tibial and femoral physes that underwent primary ACL reconstruction using a partial-transphyseal OTT technique between 2009-2018 at a single tertiary-care institution with at least twelve months of clinical follow-up were retrospectively reviewed. Patient demographics, physical examination findings, graft ruptures, return to sport, and Tegner activity levels were analyzed. Statistical significance was defined as p<0.05. ResultsOverall, 11 males and 1 female (12 knees) with a mean age of 12.8±1.8 (range: 10-16) years were included in the study. The mean postoperative follow-up of the cohort was 2.3±1.2 (range: 1.1-5.2) years. All ACLs were reconstructed with hamstring autograft with allograft augmentation utilized in a single patient. There were two cases of ACL graft rupture (16.7%). All patients were able to return to the same or higher level of sporting activity at an average of 7.4+2.7 months. There were no cases of clinically significant longitudinal or angular growth disturbance. ConclusionPartial transphyseal ACL reconstruction using a transphyseal tibial tunnel and an extra-articular OTT technique on the femur in skeletally immature patients affords minimal risk of growth disturbance with a graft rupture rate consistent with what has been reported in this high-risk population. All patients were able to return to sport at the same or higher level. Level of Evidence: IV.

Details

Title: Subtitle: Outcomes Following Primary Anterior Cruciate Ligament Reconstruction Using a Partial Transphyseal (Over-the-Top) Technique in Skeletally Immature Patients
Creators: Alan G Shamrock
Kyle R Duchman
William T Cates
Robert A Cates
Zain M Khazi
Robert W Westermann
Matthew J Bollier
Brian R Wolf
Resource Type: Journal article
Publication Details: The Iowa orthopaedic journal, Vol.42(1), pp.179-186
Publisher: Dept. of Orthopaedics, The University of Iowa; United States
PMID: 35821916
PMCID: PMC9210405
ISSN: 1541-5457
eISSN: 1555-1377
Language: English
Date published: 06/01/2022
Academic Unit: Orthopedics and Rehabilitation; Physical Therapy and Rehabilitation Science; Athletic Training Program
Record Identifier: 9984297352402771

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