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All-epiphyseal Anterior Cruciate Ligament Reconstruction Does Not Increase the Risk of Complications Compared With Pediatric Transphyseal Reconstruction

Patel, Neeraj M. MD, MPH, MBS; DeFrancesco, Christopher J. BS; Talathi, Nakul S. BS; Bram, Joshua T. BS; Ganley, Theodore J. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: August 15, 2019 - Volume 27 - Issue 16 - p e752–e757
doi: 10.5435/JAAOS-D-18-00276
Research Article

Introduction: Complication rates after physeal-sparing anterior cruciate ligament reconstruction (ACLR) are known to be high in the paediatric population compared with the adult population. However, the outcomes of these skeletally immature patients after all-epiphyseal reconstruction have not been compared with those after transphyseal reconstructions in a more similar age group. This study compares clinical outcomes and complications between all-epiphyseal and pediatric transphyseal ACLR.

Methods: We retrospectively reviewed 1,056 pediatric patients undergoing primary ACLR between 2000 and 2015. Of these, 51 were excluded (5 extra-articular and 46 partial transphyseal reconstructions). Demographic data, intraoperative findings and techniques, postoperative complications (including graft rupture, contralateral anterior cruciate ligament [ACL] tear, and meniscus injuries), clearance for sports, range of motion (ROM), and isokinetic strength testing were recorded. Univariate analysis was followed by stepwise, binary logistic regressions to control for confounding factors.

Results: During the study period, 162 patients underwent all-epiphyseal reconstruction (mean age, 12.1 ± 1.8 years) and 843 underwent transphyseal ACLR (mean age, 15.8 ± 1.9 years). At the time of surgery, more meniscus tears were found in the transphyseal group (76% versus 60%; P < 0.01). These patients also had more irreparable meniscus tears requiring partial meniscectomy (35% versus 18%; P < 0.01). Overall, the rates of graft failure, contralateral ACL injury, and new meniscus tears were 10.3%, 6.1%, and 14.2%, respectively. After controlling for confounders in a multivariate model, no difference was found in these postoperative complications between all-epiphyseal and transphyseal ACLR. Furthermore, no clinically significant difference was observed in postoperative ROM or isokinetic strength testing.

Discussion: Skeletally immature patients undergoing all-epiphyseal ACLR had less irreparable meniscus tears than older children undergoing transphyseal reconstruction. After adjusting for age and other confounders, there was no difference in postoperative ROM or strength, nor an increased risk of graft rupture, contralateral ACL injury, or new meniscus tear in these young patients compared with older adolescents undergoing transphyseal ACLR.

Level of Evidence: Level III

From the The Children's Hospital of Philadelphia, Philadelphia, PA.

Correspondence to Dr. Ganley:

Dr. Ganley or an immediate family member has received research or institutional support from Allosource and Vericel; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from Arthrex and Liberty Surgical; serves as a board member, owner, officer, or committee member of International Pediatric Orthopaedic Symposum, Pediatric Research in Sports Medicine, Philadelphia Orthopaedic Society, and Research on Osteochondritis Dissecans of the Knee. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Patel, Mr. DeFrancesco, Mr. Talathi, and Mr. Bram.

Study approval was granted by the Institutional Review Board of the Children's Hospital of Philadelphia.

© 2019 by American Academy of Orthopaedic Surgeons
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