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All-Epiphyseal ACL Reconstruction in Children: Review of Safety and Early Complications

Cruz, Aristides I. Jr MD; Fabricant, Peter D. MD, MPH; McGraw, Michael MD; Rozell, Joshua C. MD; Ganley, Theodore J. MD; Wells, Lawrence MD

Journal of Pediatric Orthopaedics: April/May 2017 - Volume 37 - Issue 3 - p 204–209
doi: 10.1097/BPO.0000000000000606
Sports Medicine

Background: All-epiphyseal anterior cruciate ligament (ACL) reconstruction is a well-described technique for skeletally immature patients. The purpose of this study was to elucidate the early complication rate and identify associated risk factors for rerupture after this procedure in children.

Methods: We retrospectively reviewed patients who underwent all-epiphyseal ACL reconstructions performed at a large, tertiary care children’s hospital between January 2007 and April 2013. Relevant postoperative data including the development of leg-length discrepancy, angular deformity, rerupture, infection, knee range of motion, arthrofibrosis, and other complications were recorded. Independent variables analyzed for association with rerupture included age, body mass index, graft type, graft size, and associated injuries addressed at surgery.

Results: A total of 103 patients (average 12.1 y old; range, 6.3 to 15.7) were analyzed. The mean follow-up was 21 months. The overall complication rate was 16.5% (17/103), including 11 reruptures (10.7%), 1 case (<1.0%) of clinical leg-length discrepancy of <1 cm, and 2 cases (1.9%) of arthrofibrosis requiring manipulation under anesthesia. Two patients (1.9%) sustained contralateral ACL ruptures and 3 (2.9%) sustained subsequent ipsilateral meniscus tears during the study period. There were no associations found between age, sex, graft type, graft thickness, body mass index, or associated injuries addressed during surgery and rerupture rate. Knee flexion continued to improve by 20 degrees on an average between the 6 weeks and 6 months postoperative visits (P<0.001; paired samples Student's t test).

Conclusions: When taken in the context of known risk of future injury in an ACL-deficient knee, all-epiphyseal ACL reconstruction in children is safe. The rate of growth disturbance in this study is similar to previous reports in this patient demographic. The rerupture rate in this cohort is slightly higher compared with ACL reconstruction in older patients.

Level of Evidence: Level IV—retrospective case series.

The Children’s Hospital of Philadelphia, Philadelphia, PA

No external funding source was utilized for this study.

The authors declare no conflicts of interest.

Reprints: Aristides I. Cruz, Jr, MD, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Wood Building, 2nd Floor, Philadelphia, PA 19103. E-mail:

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