Micheli Anterior Cruciate Ligament Reconstruction in Skeletally Immature Youths: A Retrospective Case Series With a Mean 3-Year Follow-up.
BACKGROUND
The management of anterior cruciate ligament (ACL) tears in the skeletally immature patient remains controversial. Outcomes on a physeal-sparing technique using the iliotibial band for combined intra-articular and extra-articular ACL reconstruction, called the Micheli technique, have been described and reported by the original authors.


OBJECTIVE
To evaluate the clinical outcomes of a physeal-sparing technique using the iliotibial band for combined intra-articular and extra-articular ACL reconstruction.


METHODS
Case series; Level of evidence, 4.


METHODS
Between 2005 and 2011, all patients who underwent Micheli ACL reconstruction performed by a single surgeon were identified. A minimum of 3 years' growth remaining was a prerequisite for Micheli reconstruction. Patients were excluded if postoperative follow-up was less than 1 year. Patients were evaluated for functional outcomes, satisfaction, graft survival, radiographic and clinical evidence of growth disturbance, and the need for additional procedures.


RESULTS
Twenty-one patients (22 knees) met the inclusion criteria for this study. The mean age at the time of surgery was 11.8 years (range, 9.9-14.0 years). All patients were male. There were 4 concomitant meniscal repairs and 5 partial meniscectomies performed. All patients (100%) completed follow-up at a mean duration of 3.0 years (range, 1.0-6.9 years). Overall, 6 knees (27%) underwent reoperation. Of these, 3 knees (14%) underwent revision ACL surgery: 2 revision reconstructions at 2.8 and 4.0 years postoperatively and 1 graft shrinkage at 4.7 months postoperatively. Three knees (14%) underwent subsequent meniscal procedures, including 2 partial meniscectomies and 1 meniscal repair. Of the 19 knees that did not require revision ACL surgery, the median patient satisfaction score was 10 (range, 9-10). The mean Pediatric International Knee Documentation Committee score was 96.5 ± 2.9, and the mean Lysholm score was 95.0 ± 6.1. The median preinjury Tegner activity level was 8 (range, 6-10), and the median postoperative Tegner activity level was 8 (range, 6-10). Of the 19 knees that did not require revision ACL surgery, all had a normal Lachman test result, with a firm endpoint and normal pivot shift. At follow-up, 53% of knees had closed physes. There were no angular deformities or limb-length discrepancies.


CONCLUSIONS
At a mean 3-year follow-up, the study findings confirmed excellent functional outcomes, a low ACL revision rate, and no growth disturbances. Patients returned to their preoperative activity level after reconstruction. This procedure offers a safe and effective ACL reconstruction option in children with several years of growth remaining.
Children's Orthopaedics of Atlanta, Atlanta, Georgia, USA Children's Healthcare of Atlanta at Scottish Rite, Atlanta, Georgia, USA cliff.willimon@gmail.com.
S Clifton
SC
Willimon
Children's Orthopaedics of Atlanta, Atlanta, Georgia, USA Children's Healthcare of Atlanta at Scottish Rite, Atlanta, Georgia, USA.
Christopher R
CR
Jones
Children's Healthcare of Atlanta at Scottish Rite, Atlanta, Georgia, USA.
Mackenzie M
MM
Herzog
Children's Healthcare of Atlanta at Scottish Rite, Atlanta, Georgia, USA.
Keith H
KH
May
Children's Healthcare of Atlanta at Scottish Rite, Atlanta, Georgia, USA.
Melissa J
MJ
Leake
Children's Orthopaedics of Atlanta, Atlanta, Georgia, USA Children's Healthcare of Atlanta at Scottish Rite, Atlanta, Georgia, USA.
Michael T
MT
Busch
D000293:Adolescent; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D002648:Child; D005500:Follow-Up Studies; D006132:Growth Plate / Q000502:physiology; D006801:Humans; D007718:Knee Injuries / Q000503:physiopathology / Q000601:surgery*; D065466:Lysholm Knee Score; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery; D011184:Postoperative Period; D012086:Reoperation; D012189:Retrospective Studies; D024162:Second-Look Surgery; D000070600:Tibial Meniscus Injuries
ACL; Micheli; iliotibial band; physeal sparing; skeletally immature