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Anterior Cruciate Ligament Reconstruction in Children With A Quadrupled Semitendinosus Graft: Preliminary Results With Minimum 2 Years of Follow-up

Cassard, Xavier MD*; Cavaignac, Etienne MD; Maubisson, Laurent MSc; Bowen, Mark MD, PhD§

Journal of Pediatric Orthopaedics: January 2014 - Volume 34 - Issue 1 - p 70–77
doi: 10.1097/BPO.0b013e3182a008b6
Lower Extremity

Background: The management of anterior cruciate ligament (ACL) tears in growing patients must balance activity modification with the risk of secondary (meniscal and cartilaginous) lesions, and surgical intervention, which could adversely affect skeletal growth. Many ACL reconstruction techniques have been developed or modified to decrease the risk of growth disturbance. We have not found any description of ACL reconstruction using a single hamstring, short graft implanted into intraepiphyseal, retroreamed sockets. Our hypothesis was that the technique that we used restored the knee stability and did not cause any growth disturbances.

Methods: We retrospectively studied 28 patients (20 boys, 8 girls) who presented with a unilateral ACL tear and open growth plates. We performed short graft ligament reconstruction with the semitendinosus folded into 4 strands around 2 polyethylene terephthalate tapes. The graft was implanted into sockets that were retroreamed in the femoral and tibial epiphysis and the tapes were fixed remotely by interference screws. After a minimum period of 2 years, we evaluated the comparative knee laxity, the radiographic limb morphology, the appearance of secondary lesions, and the functional outcomes using the Lysholm and Tegner scores. Comparative analyses were performed using the Student t test with subgroups depending on the type of fixation used.

Results: The mean age of the patients was 13 years (range, 9 to 15 y). The mean follow-up was 2.8 years (range, 2 to 5 y). The mean difference in laxity at 134 N was 0.3 mm, as determined using a GNRB arthrometer. No patients reported meniscal symptoms or degenerative changes. We found no angular deformity or leg length inequality. Two patients suffered a recurrent ACL tear.

Conclusions: The preliminary results from this series are consistent with prior studies demonstrating that intraepiphyseal ACL reconstruction is a safe reliable alternative for the pediatric population.

Study Design: Case series; level of evidence 4.

*Clinique des Cèdres, Cornebarrieu

CHU Rangueil1 avenue du Professeur Pouilhes

ESG Management School and Université Toulouse 1, Toulouse, France

§NorthShore Orthopaedics, Chicago, IL

None of the authors received financial support for this study.

X.C. and M.B. are consultants for FH Orthopedics. The remaining authors declare no conflict of interest.

Reprints: Etienne Cavaignac, MD, CHU Rangueil1 avenue du Professeur Pouilhes, Toulouse 31000, France. E-mail:

© 2014 by Lippincott Williams & Wilkins