Nonanatomic Anterior Cruciate Ligament Reconstruction With Double-Stranded Semitendinosus Grafts in Children With Open Physes

Demange, Marco Kawamura; Camanho, Gilberto Luís

doi:10.1177/0363546514550981

Cited by 49 publications

(46 citation statements)

References 37 publications

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“…13 In another study, a nonanatomic “over the top” doubled semitendinosis autograft reconstruction with a transphyseal tibial tunnel yielded an ipsilatearal 25% retear rate in skeletally immature patients. 4 …”

Section: Discussionmentioning

confidence: 99%

Outcomes and Complications After All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients

Wall

Ghattas²,

Eismann

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:The safest and most effective technique for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients is currently unknown.Purpose:To evaluate the functional and patient-reported outcomes of a specific all-epiphyseal ACL reconstruction technique in which the graft, bone tunnels, and fixation do not cross the knee growth plates.Study Design:Case series; Level of evidence, 4.Methods:Twenty-seven patients (23 boys, 4 girls; mean age, 11 years; range, 8-15 years) underwent an all-epiphyseal ACL reconstruction with a single femoral transverse epiphyseal tunnel and primarily split tibial epiphyseal tunnels. Outcomes were evaluated in terms of the manual Lachman test, range of motion, pain, return to activity, angular or leg-length deformity on imaging, and International Knee Documentation Committee (IKDC) or Pedi-IKDC score an average of 3.8 years postoperatively, with a minimum 2-year follow-up.Results:The mean IKDC score was 94 ± 11. There were no growth arrests, but 3 patients had knee overgrowth, and 2 required a subsequent guided growth procedure. The ACL graft failed in 4 patients (15%), and 2 patients had contralateral ACL tears (7%). There were 5 subsequent ipsilateral meniscal tears, 4 of which were retears of a repaired meniscus. Ipsilateral knee reinjury significantly correlated with the number of associated injuries at the time of index surgery (P = .040) and the number of sports played (P = .029).Conclusion:All-epiphyseal ACL reconstruction resulted in excellent long-term functional outcomes, despite a high rate of complications (48%) and secondary procedures (37%) in this highly active cohort. The incidence of graft failure was similar to other standard ACL reconstruction techniques for patients younger than 20 years.

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Section: Discussionmentioning

confidence: 99%

Outcomes and Complications After All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients

Wall

Ghattas²,

Eismann

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…Demange et al [23] reviewed their long-term results of nonanatomic partial transphyseal ACLR with double-stranded semitendinosus grafts in patients with an average age of 10.7 years, using transphyseal tibial tunnel drilling and overthe-top femoral fixation. Clinical outcomes included Lachman test, pivot-shift test, return to sports activity, and IKDC.…”

Section: Partial Transphyseal Aclrmentioning

confidence: 99%

Pediatric anterior cruciate ligament reconstruction outcomes

Peterson

Ayeni

2016

Curr Rev Musculoskelet Med

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Treatment of pediatric anterior cruciate injuries have become an area of controversy sparking much debate about best management strategies. Delaying surgery until skeletal maturity has often been shown to result in unfavorable outcomes due to concomitant meniscal and chondral injuries in this population. There have been numerous techniques used to reconstruct the ACL in the skeletally immature patient; however, most studies are limited by small patient numbers and other methodological concerns. With recent publications reporting failure rates as high as 15-25 % and growth disturbances being uncommon but now reported within almost every technical category, patient and caregiver education become of paramount importance. Key principles will be outlined that may help to avoid some of the pitfalls that occur when dealing with this unique population.

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“…The definition of what constitutes an acceptable activity restriction may vary among individuals and cultures, which explains some of the variation seen in current practice. Because you reported in those articles that you in fact performed ACL reconstruction for these indications, I presume that you feel that ACL reconstruction is likely to have a beneficial effect in these circumstances, despite your allusion to the study by Demange et al 3 In that Vol. 43, No.…”

Section: Dear Drs Moksnes and Engebretsenmentioning

confidence: 98%

It Takes More Than Timing: Response

Reider¹

2015

Am J Sports Med

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Nonanatomic Anterior Cruciate Ligament Reconstruction With Double-Stranded Semitendinosus Grafts in Children With Open Physes

Abstract: Anterior cruciate ligament reconstruction using the OTT technique in the femur and the transphyseal technique in the tibia produces good results with regard to growth plate closure but a high failure rate in adulthood.

Cited by 49 publications

References 37 publications

Outcomes and Complications After All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients

Outcomes and Complications After All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients

Pediatric anterior cruciate ligament reconstruction outcomes

It Takes More Than Timing: Response

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