title: All-Inside, All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Athletes: Return to Sport, Incidence of Second Surgery, and 2-Year Clinical Outcomes.
abstract: BACKGROUND
  Anterior cruciate ligament (ACL) injuries in skeletally immature athletes are increasing.
  
  
  OBJECTIVE
  To evaluate the 2-year clinical outcomes of all-inside, all-epiphyseal ACL reconstruction in skeletally immature athletes with 3 to 6 years of remaining growth, with a focus on return to sport and the incidence of second surgery.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Twenty-three skeletally immature athletes were prospectively evaluated after all-epiphyseal ACL reconstruction utilizing a hamstring autograft. The athletes' age, sex, sport, mechanism of injury, radiographs, and magnetic resonance imaging (MRI) findings were noted. The evaluation included a physical examination, KT-1000 arthrometer measurements, isokinetic testing, and validated outcome scores. Standing radiographs and spoiled gradient recalled echo MRI scans were obtained at 6, 12, and 24 months postoperatively. A quality of movement assessment and return-to-sport performance analysis were also performed.
  
  
  RESULTS
  Of the 23 athletes, 6 were female (mean age, 11.3 years), and 17 were male (mean age, 12.6 years). At a minimum follow-up of 2 years (range, 24-45 months), the mean International Knee Documentation Committee score was 94.6 ± 4.9, the mean Lysholm score was 97.9 ± 4.0, the mean Marx activity rating scale score was 13.4 ± 3.6, and the mean Hospital for Special Surgery Pediatric Functional Activity Brief Scale score was 23.9 ± 7.0. Lachman and pivot-shift test results were negative in all patients. The mean side-to-side difference on the KT-1000 arthrometer was 0.9 ± 0.5 mm and less tight on the operated side. No significant growth disturbances were noted; however, 6 athletes had a leg-length discrepancy of more than 5 mm (range, 6-18 mm). Two patients had overgrowth in the femur of more than 15 mm (16 mm and 18 mm). Two athletes (8.7%) required second surgery. The mean time to return to unrestricted activity was 13.5 months (range, 8-22 months).
  
  
  CONCLUSIONS
  The all-inside, all-epiphyseal ACL reconstruction technique using a hamstring autograft demonstrates excellent subjective and objective clinical outcomes in skeletally immature athletes without physeal arrest.
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Cordasco
authors.affiliation: Pediatric Orthopaedic Surgery, Children's Hospital Colorado, Aurora, Colorado, USA.
authors.forename: Stephanie Watson
authors.initials: SW
authors.lastname: Mayer
authors.affiliation: Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, New York, New York, USA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Green
mesh_terms: D000070598:Anterior Cruciate Ligament Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D004838:Epiphyses / Q000601:surgery*; D005260:Female; D005269:Femur / Q000473:pathology / Q000601:surgery; D005500:Follow-Up Studies; D000070633:Hamstring Muscles / Q000637:transplantation; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D011859:Radiography; D012086:Reoperation; D000068958:Return to Sport; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: anterior cruciate ligament; incidence of second surgery; quality of movement assessment; return to sport