title: Transphyseal anterior cruciate ligament reconstruction in patients with open physes: 10-year follow-up study.
abstract: BACKGROUND
  The treatment of anterior cruciate ligament (ACL) injuries in skeletally immature patients is controversial. Current evidence supports the view that surgical techniques restore knee stability and prevent progressive articular damage. However, most of the studies on this topic are small case series or they have short- or medium-term follow-up times.
  
  
  OBJECTIVE
  To determine the long-term functional outcomes and secondary complications of transphyseal intra-articular ACL reconstruction with hamstring graft in skeletally immature patients.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Transphyseal ACL reconstruction with autograft hamstrings was performed in 27 skeletally immature patients. The average age at surgery was 13 years (range, 12-16 years), and the average follow-up time was 10.6 years (range, 10-13 years). Clinical outcomes were assessed with preoperative and final follow-up Tegner, International Knee Documentation Committee (IKDC) subjective, and Lysholm scores. Surgery details, return to sports, and ACL reconstruction failures were collected. The anteroposterior knee laxity was assessed by arthrometry, and the presence of deformities and lower limb length discrepancies were evaluated by radiographs. The presence of degenerative signs on anteroposterior and lateral knee radiographs at final follow-up was also evaluated.
  
  
  RESULTS
  Transphyseal ACL reconstruction was performed with vertically oriented tunnels, 7 to 10 mm in diameter, using semitendinosus-gracilis autograft. The average preoperative Tegner, IKDC, and Lysholm scores were 7, 55, and 40, respectively. Significant differences in these scores were observed at the time of the final assessment (Tegner, 6 [P = .026]; IKDC, 94 [P < .001]; Lysholm, 92 [P < .001]). Two patients reported instability during sports activity. Three patients had a rupture of the ACL graft. No leg length discrepancy, axis malalignment, or degenerative changes were observed.
  
  
  CONCLUSIONS
  The transphyseal ACL reconstruction in skeletally immature patients is a safe option, with high functional and satisfaction results, without significant growth plate damage in this series of patients.
authors.affiliation: Orthopaedic Surgery Department, Clínica Alemana Santiago, Santiago, Chile.
authors.forename: Rafael
authors.initials: R
authors.lastname: Calvo
authors.affiliation: Orthopaedic Surgery Department, Clínica Alemana Santiago, Santiago, Chile.
authors.forename: David
authors.initials: D
authors.lastname: Figueroa
authors.affiliation: Orthopaedic Surgery Department, Clínica Alemana Santiago, Santiago, Chile.
authors.forename: Federico
authors.initials: F
authors.lastname: Gili
authors.affiliation: Orthopaedic Surgery Department, Clínica Alemana Santiago, Santiago, Chile.
authors.forename: Alex
authors.initials: A
authors.lastname: Vaisman
authors.affiliation: Orthopaedic Surgery Department, Clínica Alemana Santiago, Santiago, Chile.
authors.forename: Pablo
authors.initials: P
authors.lastname: Mocoçain
authors.affiliation: Orthopaedic Surgery Department, Clínica Alemana Santiago, Santiago, Chile maxespinosa@gmail.com.
authors.forename: Maximiliano
authors.initials: M
authors.lastname: Espinosa
authors.affiliation: Orthopaedic Surgery Department, Clínica Alemana Santiago, Santiago, Chile.
authors.forename: Agustín
authors.initials: A
authors.lastname: León
authors.affiliation: Orthopaedic Surgery Department, Clínica Alemana Santiago, Santiago, Chile.
authors.forename: Sergio
authors.initials: S
authors.lastname: Arellano
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D002648:Child; D004838:Epiphyses; D005260:Female; D005500:Follow-Up Studies; D006132:Growth Plate / Q000378:metabolism; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000473:pathology / Q000601:surgery; D008297:Male; D012189:Retrospective Studies; D012421:Rupture / Q000473:pathology; D013177:Sports; D013710:Tendons / Q000637:transplantation*; D014182:Transplantation, Autologous
keywords: anterior cruciate ligament reconstruction; long-term follow-up; skeletally immature patients; transphyseal reconstruction