title: Nonanatomic anterior cruciate ligament reconstruction with double-stranded semitendinosus grafts in children with open physes: minimum 15-year follow-up.
abstract: BACKGROUND
  Nonanatomic anterior cruciate ligament (ACL) reconstruction (ACLR) with double-stranded semitendinosus grafts in children with open physes has been described as a successful surgical technique in short-term follow-up clinical reports.
  
  
  OBJECTIVE
  To evaluate the clinical outcomes of nonanatomic ACLR in children with open physes and a minimum of 15 years' follow-up.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Twelve patients with an average age of 10.7 years (range, 8.3-12.4 years) underwent ACLR between 1991 and 1998. All patients were classified as Tanner development stage 2 or lower. The surgical technique involved transphyseal tibial tunnel drilling and over-the-top (OTT) femoral fixation using a double-stranded graft for all patients. Clinical outcomes were evaluated in terms of the manual Lachman test, pivot-shift test, return to sports activity, and International Knee Documentation Committee (IKDC) score at the end of growth and at a minimum 15-year follow-up (range, 15-22 years).
  
  
  RESULTS
  No clinically significant growth disturbance was observed. Ten patients had a grade A IKDC score, and 2 patients had a grade B IKDC score at the end of growth. There was no progression of laxity or modification of knee stability with growth. Three patients (25%) had ACL reruptures during sports activities after growth plate closure. All patients with reruptured ACLs underwent additional reconstructive surgery.
  
  
  CONCLUSIONS
  Anterior cruciate ligament reconstruction using the OTT technique in the femur and the transphyseal technique in the tibia produces good results with regard to growth plate closure but a high failure rate in adulthood.
authors.affiliation: Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil demange@usp.br.
authors.forename: Marco Kawamura
authors.initials: MK
authors.lastname: Demange
authors.affiliation: Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Gilberto Luis
authors.initials: GL
authors.lastname: Camanho
mesh_terms: D000293:Adolescent; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction; D001182:Arthroscopy; D002648:Child; D004838:Epiphyses / Q000254:growth & development; D005260:Female; D005269:Femur / Q000254:growth & development / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013710:Tendons / Q000637:transplantation*; D013977:Tibia / Q000254:growth & development / Q000601:surgery
keywords: anterior cruciate ligament; children; knee instability; open physes