Transphyseal anterior cruciate ligament reconstruction in patients with open physes.
OBJECTIVE
The purpose of this study was to evaluate the clinical outcomes of transphyseal anterior cruciate ligament (ACL) reconstruction in patients with open physes.


METHODS
Transphyseal ACL reconstruction was performed in 26 patients with open tibial and femoral physes (physis >2 mm) by use of autogenous quadrupled hamstrings as grafts. Meniscal tearing was found in 65.3% of the patients. Partial chondral defect injury on the medial femoral condyle was found 6 months after injury in only 2 patients (7.69% of all patients). The mean follow-up period was 45 +/- 18.3 months. Clinical outcomes were evaluated by use of the International Knee Documentation Committee score and Lysholm Knee Scoring Scale, and the anteroposterior stability was objectively measured by use of KT-1000 arthrometer (MEDmetric, San Diego, CA). Possible length and angular discrepancies were observed by conventional radiography in a long film and scanograms of the lower limbs.


RESULTS
The mean length discrepancy between the operated lower limb and the contralateral limb was 1.2 +/- 3.2 mm (range, -7 to 7 mm). The mean angular deviation difference between the lower limbs was 0.46 degrees +/- 1.1 degrees . New traumatic injuries developed in 3 patients, in whom surgical revision was performed; 1 patient underwent a late meniscectomy. The mean difference in KT-1000 measurement was 2.0 +/- 1.0 mm. The mean subjective International Knee Documentation Committee score was 91.5 +/- 5.7, and the mean score on the modified Lysholm scale was 93.5 +/- 4. Of the patients, 3 (11.2% of all patients) could not return to the same level of physical activity as before injury.


CONCLUSIONS
ACL reconstruction by use of the transphyseal technique in an immature skeleton with a hamstring autograft, with careful attention being paid to the technique, resulted in good clinical outcomes and no growth abnormalities.


METHODS
Level IV, therapeutic case series.
Cohen
Moises
M
Orthopedic Sports Medicine Division, Department of Orthopaedic Surgery and Traumatology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil. m.cohen@uol.com.br
Ferretti
Mario
M
Quarteiro
Marcelo
M
Marcondes
Frank B
FB
de Hollanda
João P B
JP
Amaro
Joicemar T
JT
Abdalla
Rene J
RJ
D000293:Adolescent; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D004838:Epiphyses / Q000000981:diagnostic imaging; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006132:Growth Plate / Q000000981:diagnostic imaging* / Q000254:growth & development; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008592:Menisci, Tibial / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000706:statistics & numerical data; D020127:Recovery of Function; D012189:Retrospective Studies; D013710:Tendons / Q000637:transplantation; D013977:Tibia / Q000000981:diagnostic imaging; D000070600:Tibial Meniscus Injuries; D014182:Transplantation, Autologous; D016896:Treatment Outcome