title: Transphyseal anterior cruciate ligament reconstruction in the skeletally immature: follow-up to a minimum of sixteen years of age.
abstract: BACKGROUND
  The evidence in favor of early surgical treatment of anterior cruciate ligament (ACL) injuries in children is increasing. However, the controversy regarding the safety of such a procedure in young athletes with wide open physes remains unresolved.
  
  
  METHODS
  We reviewed prospectively collected outcome data on consecutive patients who had undergone transphyseal ACL reconstruction at either (1) an age of less than fourteen years and Tanner stage 1 or 2, or (2) an age of less than twelve years and Tanner stage 3. Children who had less than four years of follow-up, who were younger than sixteen years at the time of final follow-up, or who had been at Tanner stage 4 at the time of surgery were excluded. Twenty-eight of the thirty-two included patients had been at Tanner stage 1 or 2 at the time of surgery, and the remaining four had been at Tanner stage 3 but had been younger than twelve years of age. The mean age at the time of the surgery was 11.25 years (range, 9.5 to 14.0 years; median, 12.1 years). The mean duration of follow-up was 72.3 months (range, forty-eight to 129 months; median, seventy-two months).
  
  
  RESULTS
  The mean Lysholm score improved from 71.5 preoperatively to 95.86 postoperatively (p < 0.0001). The mean Tegner activity scale score improved from 4.03 to 7.66 (p < 0.0001), which was comparable with the preinjury score of 8.0. One patient had a mild valgus deformity with no functional disturbance, and none had a limb-length discrepancy. One rerupture occurred, but all other patients had a good or excellent outcome.
  
  
  CONCLUSIONS
  This case series indicates good long-term results of ACL reconstruction with use of a transphyseal technique in young children.
authors.affiliation: Department of Orthopaedics, St. Mary's Hospital, London, United Kingdom.
authors.forename: Sujit
authors.initials: S
authors.lastname: Kumar
authors.forename: David
authors.initials: D
authors.lastname: Ahearne
authors.forename: David M
authors.initials: DM
authors.lastname: Hunt
mesh_terms: D000293:Adolescent; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction; D001182:Arthroscopy; D002648:Child; D004838:Epiphyses / Q000254:growth & development; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D012421:Rupture; D016896:Treatment Outcome