Preoperative evaluation and anterior cruciate ligament reconstruction technique for skeletally immature patients in Tanner stages 2 and 3.
BACKGROUND
Transphyseal anterior cruciate ligament reconstruction in skeletally immature patients carries the risk of adverse sequelae.


OBJECTIVE
1) To provide clinical and radiographic methods to identify skeletally immature patients with significant remaining lower limb growth. 2) To provide a method for calculating the percent area lesion created by a 6-mm distal femoral physeal tunnel. 3) To present a method of partial transphyseal intraarticular anterior cruciate ligament reconstruction with bipolar graft fixation in these patients. 4) To report on clinical, functional, and radiographic results at skeletal maturity.


METHODS
Fourteen adolescents with symptomatic anterior cruciate ligament instability who were identified as being in Tanner stages 2 and 3 underwent partial transphyseal intraarticular anterior cruciate ligament reconstruction with the use of hamstring tendon grafts (transphyseal only in the femur and through the epiphysis in the tibia).


RESULTS
At skeletal maturity, 10 patients were asymptomatic and fully active in sports. No patient had significant leg-length inequality or angular deformity after use of a 6-mm femoral physeal tunnel, which represented 1) less than 7% of the frontal plane and 2) less than 1% of the transverse plane cross-sectional femoral physeal areas.


CONCLUSIONS
The choice of the exposed technique and the method used to select patients permitted us to avoid adverse sequelae.
Guzzanti
Vincenzo
V
Orthopaedic Department, the Children's Hospital Bambino Gesù, Rome, Italy.
Falciglia
Francesco
F
Stanitski
Carl L
CL
D000293:Adolescent; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy; D001846:Bone Development; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures; D000070600:Tibial Meniscus Injuries; D016896:Treatment Outcome