title: Outcome of anatomic transphyseal anterior cruciate ligament reconstruction in Tanner stage 1 and 2 patients with open physes.
abstract: BACKGROUND
  Anterior cruciate ligament (ACL) injuries are being seen with increasing frequency in children. Treatment of the ACL-deficient knee in skeletally immature patients is controversial.
  
  
  OBJECTIVE
  To determine the outcome of all-arthroscopic transphyseal anatomic single-bundle ACL reconstruction in Tanner stage 1 and 2 patients at a minimum of 2 years after surgery.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Between 2007 and 2008, 16 prepubescent patients underwent ACL reconstruction using soft tissue grafts. All patients were Tanner stage 1 and 2. Outcomes were assessed at a minimum of 2 years after surgery and included limb alignment, limb length, instrumented testing with the KT-1000 arthrometer, and International Knee Documentation Committee (IKDC) score.
  
  
  RESULTS
  Mean age at the time of surgery was 12 years (range, 8-14 years). Graft choices included the following: living donor-related hamstring tendon allograft (n = 14), hamstring tendon autograft (n = 1), and fresh-frozen allograft (n = 1). Mean IKDC subjective score was 96 (range, 84-100). All patients had a stable knee postoperatively. Eleven patients had a negative Lachman test result, and 14 had a negative pivot-shift test result. The remainder had grade 1 Lachman and pivot-shift test findings, respectively. At 2 years after surgery, all patients had returned to strenuous activities, and normal or nearly normal overall IKDC score was documented in 94% of patients. There were no cases of limb malalignment or growth arrest.
  
  
  CONCLUSIONS
  We present a case series of transphyseal anatomic single-bundle ACL reconstruction in Tanner stage 1 and 2 patients at a minimum of 2 years after surgery. Excellent clinical outcomes were obtained with high levels of return to desired activities. Importantly, no growth disturbances were seen in this series of patients.
authors.affiliation: North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hui
authors.forename: Justin
authors.initials: J
authors.lastname: Roe
authors.forename: Duncan
authors.initials: D
authors.lastname: Ferguson
authors.forename: Alison
authors.initials: A
authors.lastname: Waller
authors.forename: Lucy
authors.initials: L
authors.lastname: Salmon
authors.forename: Leo
authors.initials: L
authors.lastname: Pinczewski
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D041923:Adolescent Development; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods* / Q000534:rehabilitation; D001182:Arthroscopy; D001265:Athletic Injuries / Q000534:rehabilitation / Q000601:surgery; D002648:Child; D002657:Child Development; D005260:Female; D005269:Femur / Q000254:growth & development; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D020127:Recovery of Function; D012189:Retrospective Studies; D013710:Tendons / Q000637:transplantation; D016896:Treatment Outcome