title: Anterior cruciate ligament reconstruction in children with a quadrupled semitendinosus graft: preliminary results with minimum 2 years of follow-up.
abstract: BACKGROUND
  The management of anterior cruciate ligament (ACL) tears in growing patients must balance activity modification with the risk of secondary (meniscal and cartilaginous) lesions, and surgical intervention, which could adversely affect skeletal growth. Many ACL reconstruction techniques have been developed or modified to decrease the risk of growth disturbance. We have not found any description of ACL reconstruction using a single hamstring, short graft implanted into intraepiphyseal, retroreamed sockets. Our hypothesis was that the technique that we used restored the knee stability and did not cause any growth disturbances.
  
  
  METHODS
  We retrospectively studied 28 patients (20 boys, 8 girls) who presented with a unilateral ACL tear and open growth plates. We performed short graft ligament reconstruction with the semitendinosus folded into 4 strands around 2 polyethylene terephthalate tapes. The graft was implanted into sockets that were retroreamed in the femoral and tibial epiphysis and the tapes were fixed remotely by interference screws. After a minimum period of 2 years, we evaluated the comparative knee laxity, the radiographic limb morphology, the appearance of secondary lesions, and the functional outcomes using the Lysholm and Tegner scores. Comparative analyses were performed using the Student t test with subgroups depending on the type of fixation used.
  
  
  RESULTS
  The mean age of the patients was 13 years (range, 9 to 15 y). The mean follow-up was 2.8 years (range, 2 to 5 y). The mean difference in laxity at 134 N was 0.3 mm, as determined using a GNRB arthrometer. No patients reported meniscal symptoms or degenerative changes. We found no angular deformity or leg length inequality. Two patients suffered a recurrent ACL tear.
  
  
  CONCLUSIONS
  The preliminary results from this series are consistent with prior studies demonstrating that intraepiphyseal ACL reconstruction is a safe reliable alternative for the pediatric population.
  
  
  METHODS
  Case series; level of evidence 4.
authors.affiliation: *Clinique des Cèdres, Cornebarrieu †CHU Rangueil1 avenue du Professeur Pouilhes ‡ESG Management School and Université Toulouse 1, Toulouse, France §NorthShore Orthopaedics, Chicago, IL.
authors.forename: Xavier
authors.initials: X
authors.lastname: Cassard
authors.forename: Etienne
authors.initials: E
authors.lastname: Cavaignac
authors.forename: Laurent
authors.initials: L
authors.lastname: Maubisson
authors.forename: Mark
authors.initials: M
authors.lastname: Bowen
mesh_terms: D000293:Adolescent; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects / Q000379:methods*; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007593:Joint Instability / Q000517:prevention & control; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D010149:Postoperative Pain / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D013710:Tendons / Q000637:transplantation*; D013997:Time Factors; D016896:Treatment Outcome