title: Complications after epiphyseal reconstruction of the anterior cruciate ligament in prepubescent children.
abstract: OBJECTIVE
  Reconstruction of the anterior cruciate ligament (ACL) remains a major concern in the prepubescent, skeletally immature patient with wide open growth plates. Different surgical techniques have been proposed. This study reports the results and complications of ACL reconstruction in young children using an all epiphyseal technique.
  
  
  METHODS
  Between 2006 and 2010, 12 patients (10-13 years, median 12.1 years) underwent epiphyseal primary ACL reconstruction, with a total of 13 knee procedures. Patients were assessed retrospectively with a median follow-up of 54 months (range 39-80 months) consisting of a clinical examination, instrumented arthrometer testing and radiological analysis. Functional status was assessed using the Lysholm knee score, Tegner activity scale and IKDC-2000 form.
  
  
  RESULTS
  According to the IKDC examination form, five knees were rated as normal, six near normal and two abnormal. The median IKDC score at follow-up was 88.5 points (range 75-99 points). The mean side-to-side difference in KT-1000 ligament laxity testing was 1.5 mm (±2.5 mm). In two patients, reoperation was necessary due to graft failure. Two patients developed significant leg length inequality; one with 20 mm overgrowth and varus malalignment after re-reconstruction and the second developed arthrofibrosis and overgrowth of 16 mm. Four patients had minor limb length discrepancy ranging between +5 and +10 mm; no growth arrest was noted. One patient with an intact but slightly elongated graft required a meniscal suture 34 months after ACL reconstruction following a traumatic medial meniscal lesion.
  
  
  CONCLUSIONS
  Despite using the epiphyseal technique in ACL reconstruction, relevant growth discrepancy can occur. Thereby, overgrowth rates appear to potentially pose a major clinical problem, which has remained unreported so far. Overall, there is a considerable high risk of complications in this patient group.
  
  
  METHODS
  IV.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Kantonsspital Winterthur, Brauerstrasse 15, Postfach 834, 8401, Winterthur, Switzerland.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Koch
authors.affiliation: Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland.
authors.forename: Sandro F
authors.initials: SF
authors.lastname: Fucentese
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Kantonsspital Winterthur, Brauerstrasse 15, Postfach 834, 8401, Winterthur, Switzerland. samuel.blatter@ksw.ch.|Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland. samuel.blatter@ksw.ch.
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Blatter
mesh_terms: D000293:Adolescent; D000070598:Anterior Cruciate Ligament Injuries / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects*; D002648:Child; D004838:Epiphyses / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D007870:Leg Length Inequality / Q000209:etiology; D008297:Male; D012189:Retrospective Studies
keywords: Anterior cruciate ligament; Children; Epiphyseal; Growth; Reconstruction