Complication rates following all-epiphyseal ACL reconstructions in skeletally immature patients

Saad, Lydia; Grimard, Guy; Nault, Marie-Lyne

doi:10.1097/md.0000000000027959

Cited by 7 publications

(3 citation statements)

References 47 publications

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“…[ 96 ] Arthroscopy Retrospective 58 42.0 All-epiphyseal 8 8 11.4 1 Saad et al. [ 97 ] Medicine (Baltimore) Retrospective 66 19.2 All-epiphyseal 18 19 13.3 4 Sasaki et al. [ 98 ] Orthop J Sports Med Retrospective 74 41.6 All-epiphyseal 18 18 12.4 10 38.1 Trans-epiphyseal 84 84 14.1 75 Seon et al.…”

Section: Resultsmentioning

confidence: 99%

“…The authors used heterogeneous types of autografts. Among them, hamstring [ 57 , 58 , 62 , 64 – 68 , 75 – 77 , 79 , 82 – 85 , 89 , 92 – 95 , 97 , 99 , 100 , 104 , 106 , 107 ], patellar [ 60 , 63 , 87 , 88 , 96 , 101 , 106 ] and iliotibial band [ 80 , 90 , 91 , 105 , 106 ] autografts were most commonly used. Given the lack of quantitative data and limited information, the types of autografts used could not be analyzed separately.…”

Section: Discussionmentioning

confidence: 99%

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All-epiphyseal anterior cruciate ligament reconstruction yields superior sports performances than the trans-epiphyseal technique in skeletally immature patients: a systematic review

Migliorini,

Pilone,

Memminger

et al. 2024

J Orthop Traumatol

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Background Anterior cruciate ligament (ACL) tears in skeletally immature patients are increasingly common. Evidence comparing the outcomes of all-epiphyseal versus trans-epiphyseal ACL reconstruction in skeletally immature patients is limited, and the current literature could benefit from a comprehensive systematic review. The present study compared all-epiphyseal versus trans-epiphyseal ACL reconstruction in skeletally immature patients. The outcomes of interest were to compare joint laxity, patient-reported outcome measures (PROMs), return to sport, and complications. Methods This study was conducted according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In November 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. No additional filters were used in the database search. All the clinical studies investigating ACL reconstruction in skeletally immature patients were accessed. Only articles that clearly stated the surgical technique (all- or trans-epiphyseal) were eligible. Only articles with a minimum of 6 months of follow-up were included. Only articles that clearly stated that surgeries were conducted in children with open physis were eligible. Results Data from 1489 patients (1493 procedures) were collected, of which 32% (490 of 1489 patients) were female. The mean length of follow-up was 46.6 months. The mean age of the patients was 12.7 years. No difference was found in joint laxity (Table 3): positive pivot shift (P = 0.4), positive Lachman test (P = 0.3), and mean arthrometer laxity (P = 0.1). No difference was found in PROMs (Table 4): International Knee Documentation Committee (IKDC) (P = 0.3), Lysholm (P = 0.4), and Tegner (P = 0.7). The trans-epiphyseal technique was associated with a greater rate of patients unable to return to sports (1% versus 7%, P = 0.0001) and with a longer time to return to sports (7.7 versus 8.6 months, P = 0.01). Though the trans-epiphyseal technique was associated with a lower rate of return to sport, this difference was not statistically significant (P = 0.8). No difference was evidenced in the rate of patients who had reduced their league or level of sports activity (P = 0.6) or in the rate of patients who had returned to their previous league or level of sports activity (P = 0.7). No difference was found in the rate of complication: re-tear (P = 0.8), reoperation (P = 0.7), increased laxity (P = 0.9), and persistent instability sensation (P = 0.3). Conclusion Trans-epiphyseal ACL reconstruction was associated with a greater rate of patients unable to return to sport and with a longer time to return to sport compared with the all-epiphyseal technique in skeletally immature patients. Level of evidence Level III, systematic review.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

All-epiphyseal anterior cruciate ligament reconstruction yields superior sports performances than the trans-epiphyseal technique in skeletally immature patients: a systematic review

Migliorini,

Pilone,

Memminger

et al. 2024

J Orthop Traumatol

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“…[5][6][7] These secondary injuries can have a substantial impact on patients in terms of both physical health and overall wellbeing. [8,9] Investigating the risk factors for secondary injuries after ACL reconstruction is crucial for prevention and management.…”

Section: Introductionmentioning

confidence: 99%

Abnormal femoral trochlea morphology is a risk factor for secondary injury of anterior cruciate ligament after reconstruction

Cai,

Wang,,

Yan

et al. 2024

Medicine

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Secondary injury of the anterior cruciate ligament (ACL) is a common concern after anterior cruciate ligament (ACL) reconstruction, and identification of morphological risk factors is essential to prevent these injuries. We hypothesized that abnormal femoral trochlea morphology is associated with secondary ACL injuries after reconstruction. This study aimed to investigate the relationship between femoral trochlear morphology and secondary ACL injuries after reconstruction. A retrospective analysis was conducted on 20 patients who experienced secondary ACL injuries after reconstruction in our hospital between 2017 and 2022 (experimental group), and 40 patients were included in the control group. The following femoral trochlear characteristics were compared between the 2 groups: medial condylar height (MCH), trochlear sulcus height (TSH), lateral condylar height (LCH), trochlear sulcus depth (TSD), trochlear sulcus angle (TSA), medial trochlear inclination (MTI), and lateral trochlear inclination (LTI). The study found that patients in the secondary ACL injury after reconstruction group exhibited the following differences when compared to the control group: decreased MCH (56.33 ± 3.52 vs 59.93 ± 3.24, P value = .015), decreased TSD (4.89 ± 1.56 vs 6.98 ± 1.23, P value ˂ .001), decreased MTI (12.54 ± 6.57 vs 19.45 ± 6.35, P value ˂ .001), and increased TSA (145.23 ± 9.76 vs 139.25 ± 8.42, P value ˂ .001). This study demonstrated a significant correlation between abnormal femoral trochlear morphological characteristics and secondary ACL injuries after reconstruction. Decreased MCH, TSD, and MTI along with increased TSA are associated with a higher risk of secondary ACL injury. These data could thus help identify individuals susceptible to secondary ACL injuries after reconstruction.

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Anterior cruciate ligament reconstruction in skeletally immature patients is effective: A systematic review

Migliorini,

Cocconi,

Schäfer

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe present study evaluated the outcomes of anterior cruciate ligament (ACL) reconstruction in children with open physes. The outcomes of interest were to compare the increase in joint laxity and PROMs from baseline to the last follow‐up, the rate and features of the return to sport and the rate of complications.MethodsThis study was conducted according to the 2020 PRISMA guidelines. In October 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar and Embase. All the clinical studies investigating ACL reconstruction in skeletally immature patients were accessed. Only articles which clearly stated that surgeries were conducted in children with open physis were eligible.ResultsData from 53 studies (1691 procedures) were collected. 35% (597 out of 1691 patients) were women. The mean length of the follow‐up was 44.7 ± 31.3 months. The mean age of the patients was 12.7 ± 1.1 years old. All PROMs significantly improved from the baseline values to those at the last follow‐up. The mean time to return to sport was 8.3 ± 1.9 months. 89% (690 out of 771 patients) returned to sports, 15% (109 out of 721 patients) reduced their level of sports activity or league, and 84% (651 out of 771 patients) returned to their previous level of sport. 9% (112 out of 1213) of patients experienced re‐tear of the reconstructed ACL, and 11% (75 out of 660) of patients underwent a further ACL reoperation. No patients (0 out of 83) demonstrated increased laxity at the last follow‐up, and persistent sensation of instability was reported by 5% (11 out of 235) of patients.ConclusionACL reconstruction in skeletally immature patients is effective and safe, and is associated with fast recovery and a high rate of return to sport.Level of EvidenceLevel IV.

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Complication rates following all-epiphyseal ACL reconstructions in skeletally immature patients

Cited by 7 publications

References 47 publications

All-epiphyseal anterior cruciate ligament reconstruction yields superior sports performances than the trans-epiphyseal technique in skeletally immature patients: a systematic review

All-epiphyseal anterior cruciate ligament reconstruction yields superior sports performances than the trans-epiphyseal technique in skeletally immature patients: a systematic review

Abnormal femoral trochlea morphology is a risk factor for secondary injury of anterior cruciate ligament after reconstruction

Anterior cruciate ligament reconstruction in skeletally immature patients is effective: A systematic review

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