title: Anatomical "C"-shaped double-bundle versus single-bundle anterior cruciate ligament reconstruction in pre-adolescent children with open growth plates.
abstract: OBJECTIVE
  To analyse the clinical, rotational and radiological (MRI) results of paediatric anatomical "C-shaped" double-bundle (DB) anterior cruciate ligament (ACL) reconstruction with anteromedial and posteromedial bundle compared to single-bundle (SB) ACL reconstruction.
  
  
  METHODS
  Between 2008 and 2014, 57 consecutive patients received a paediatric ACL reconstruction with open physis and were allocated into two groups, according to the surgical procedure. Transepiphyseal SB technique was used until 2012 and DB consecutively thereafter. Follow-up consisted of a clinical evaluation with assessment of the International Knee Documentation Committee (IKDC) form, the Lysholm knee score, Tegner activity score, KT-1000 arthrometer evaluation, VAS Scores for satisfaction, MRI and testing of rotational stability using a robotic system.
  
  
  RESULTS
  The mean time from ACL reconstruction to follow-up was 48.1 ± 15.8 in the SB group (n = 17) and 23.1 ± 13.2 in the DB group (n = 16; p < 0.001). No differences were found in the subjective scores. Biomechanically, there were significant differences identified in the KT-1000 (p < 0.03) and total tibial axial rotation (p < 0.04) when evaluating the reconstructed knee only. Ten of 17 (59%) of the SB patients had a Joint Play Area within the acceptable range of the median healthy knee value compared to 100 % in the DB group. Decreased patient satisfaction was associated with increased total tibial axial rotation. No growth disturbance was observed. Overall, 98% of patients were reached and either examined or interviewed. Re-rupture rate was 3 of 21 (14.3%) for DB and 9 of 35 (25.7%) for SB. All but one re-ruptures (92%) happened in the first 16 postoperative months independent of technique.
  
  
  CONCLUSIONS
  The re-rupture rate after pre-adolescent ACL reconstruction is too high both historically and in this mixed cohort. Anatomical transepiphyseal DB ACL reconstruction with open physis may result in a reduction in this re-rupture rate, which may be related to a tighter control of the Joint Play Area. While subjective clinical results were similar between SB and DB, decreased patient satisfaction was associated with increased total tibial axial rotation in the entire cohort. Despite the need for two transepiphyseal tunnels in the DB technique, there did not appear to be an increased risk in growth plate disturbance. Transepiphyseal DB ACL reconstruction appears to be a reasonable alternative to current techniques in pre-adolescent children with an ACL rupture.
  
  
  METHODS
  IV.
authors: Institute for Anatomy and Cell Biology, Ruprecht-Karls-University, Heidelberg, Germany. rainer.siebold@atos.de.|HKF - International Center for Hip, Knee and Foot Surgery and Sports Traumatology, ATOS Klinik Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany. rainer.siebold@atos.de.
authors: Rainer
authors: R
authors: Siebold
authors: HKF - International Center for Hip, Knee and Foot Surgery and Sports Traumatology, ATOS Klinik Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany.|Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors: Tsuyoshi
authors: T
authors: Takada
authors: HKF - International Center for Hip, Knee and Foot Surgery and Sports Traumatology, ATOS Klinik Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany.
authors: Sven
authors: S
authors: Feil
authors: HKF - International Center for Hip, Knee and Foot Surgery and Sports Traumatology, ATOS Klinik Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany.
authors: Carmen
authors: C
authors: Dietrich
authors: University Orthopedics, 441 Armour Place NE, Atlanta, GA, 30324, USA.
authors: Shaun K
authors: SK
authors: Stinton
authors: University Orthopedics, 1014 Sycamore Drive, Decatur, GA, 30030, USA.|Morehouse College, University Orthopedics, Atlanta, GA, USA.
authors: Thomas P
authors: TP
authors: Branch
mesh_terms: D000293:Adolescent; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D065466:Lysholm Knee Score; D008297:Male; D017060:Patient Satisfaction; D012008:Recurrence; D013710:Tendons / Q000637:transplantation*
keywords: ACL reconstruction; Adolescents; Anteromedial bundle; Children; Double bundle; Internal rotation; Open physis; Posteromedial bundle; RKT; Single bundle