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Technique for partial transphyseal anterior cruciate ligament reconstruction in skeletally immature athletes

preliminary results

Bettin, Clayton C. MD; Throckmorton, Thomas W. MD; Miller, Robert H. III MD; Azar, Frederick M. MD

doi: 10.1097/BCO.0000000000000713
SPECIAL FOCUS: Sports Medicine Rotation

Background: A number of safe and successful surgical techniques to avoid physeal injury about the knee have been described, but their reported outcomes have not equaled success rates of procedures in skeletally mature patients. The purpose of this study was to determine the outcomes of an arthroscopic-assisted ACL reconstruction using a quadruple-looped hamstring graft with a synthetic graft extender and a physeal-sparing technique for partial transphyseal ACL reconstruction in skeletally immature patients.

Methods: Medical record review identified skeletally immature patients who had this procedure and a minimum 6-month follow-up. A quadrupled-looped hamstring autograft and a synthetic graft extender allowed the optimal portion of the graft to be placed intra-articular and maintain sufficient length for proximal and distal fixation. Repeat physical examination included KT-1000 measurement, scanogram, and completion of a Lysholm knee scale and International Knee Documentation Committee (IKDC) evaluation.

Results: Seventeen male patients 7.7 to 14.9 yr who fit the inclusion criteria were identified. All had open tibial and femoral physes at the time of ACL reconstruction. Average follow-up was 2 yr. At latest follow-up, all patients had stable Lachman tests and were able to return to sporting activities at their previous levels. Average limb-length discrepancy was 2.2 mm, with an average angular difference of 1.7 degrees, neither of which was statistically or clinically significant. Average Lysholm score was 91.5, and the average IKDC score was 92.7.

Conclusions: This technique can restore motion and stability after ACL injury in skeletally immature patients while minimizing the risk of growth disturbance that might result in length or angular deformities.

Level of Evidence: IV.

University of Tennessee-Campbell Clinic, Department of Orthopaedics and Biomedical Engineering, Memphis TN

Financial Disclosure: Dr. Throckmorton discloses a financial relationship outside this work with Zimmer Biomet, Pacira, Gilead, and Elsevier. Dr. Azar discloses a financial relationship outside this work with 98point6, Iovera, Zimmer, Pfizer, and Elsevier. Dr. Miller discloses a financial relationship outside this work with Elsevier. Dr. Bettin has no disclosures. The authors report no conflicts of interest in regard to this work.

Correspondence to Clayton C. Bettin, MD, 1211 Union Avenue, Suite 510, Memphis TN 38104 Tel: +901-759-3270; fax: +901-759-3278; e-mail:

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