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. 2021 Nov 10;9(11):23259671211051308.
doi: 10.1177/23259671211051308. eCollection 2021 Nov.

Clinical Outcomes and Postoperative Complications After All-Epiphyseal Double-Bundle ACL Reconstruction for Skeletally Immature Patients

Shizuka Sasaki  1 , Eiji Sasaki  1 , Yuka Kimura  1 , Yuji Yamamoto  1 , Eiichi Tsuda  2 , Yasuyuki Ishibashi  1
Affiliations

Clinical Outcomes and Postoperative Complications After All-Epiphyseal Double-Bundle ACL Reconstruction for Skeletally Immature Patients

Shizuka Sasaki et al. Orthop J Sports Med. .

Abstract

Background: The treatment strategy for pediatric anterior cruciate ligament (ACL) tears, especially in patients with open physes, remains controversial.

Purpose: To assess clinical outcomes and postoperative complications after all-epiphyseal double-bundle ACL (DB-ACL) reconstruction for patients with open physes.

Study design: Cohort study; Level of evidence, 3.

Methods: Included were 102 patients aged ≤15 years who underwent ACL reconstruction at a single institution and had a minimum of 2 years of follow-up. Of these patients, 18 had undergone all-epiphyseal DB-ACL reconstruction (mean age, 12.4 ± 1.2 year) and 84 had undergone conventional DB-ACL reconstruction (mean age, 14.1 ± 0.9 year). The outcomes of the all-epiphyseal group were compared with those of the conventional group. Objective clinical outcomes included KT-1000 arthrometer measurements of side-to-side difference in anterior tibial translation, Lachman test grade, and pivot-shift test grade. Radiographic angular deformity (defined as >3° of the side-to-side difference in femorotibial angle) and incidence of second ACL injury were also compared.

Results: The postoperative side-to-side difference in laxity significantly improved from 6.1 ± 2.4 to 0.6 ± 0.9 mm in the all-epiphyseal group (P = .001), and postoperative laxity was similar to that of the conventional group (0.4 ± 0.8 mm; P = .518). A Lachman grade 1 positive result was observed in 20% of the all-epiphyseal group and 3% of the conventional group (P = .042), and a pivot-shift grade 1 positive result was observed in 22% of the all-epiphyseal group and 4% of the conventional group (P = .074). A total of 4 patients (26.7%) in the all-epiphyseal group and 4 (6.1%) in the conventional group demonstrated angular deformity (P = .035). The incidence of postoperative ipsilateral ACL tear was 16.7% in the all-epiphyseal group and 23.8% in the conventional group (P = .757). The incidence of contralateral ACL tear was 11.1% in the all-epiphyseal group and 14.3% in the conventional group (P ≥ .999).

Conclusion: All-epiphyseal DB-ACL reconstruction for skeletally immature patients achieved satisfactory clinical outcomes compared with conventional DB-ACL reconstruction. The incidence of ipsilateral graft rupture was relatively high in both groups. The all-epiphyseal group had a significantly higher incidence of angular deformity.

Keywords: all-epiphyseal technique; anterior cruciate ligament reconstruction; double-bundle reconstruction; pediatric.

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Conflict of interest statement

The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
All-epiphyseal double-bundle anterior cruciate ligament reconstruction. Intraoperative radiographs: (A) anteroposterior and (B) lateral view. Postoperative radiographs: (C) anteroposterior and (D) lateral view. Three-dimensional computed tomography images: (E) medial view of femoral tunnels and (F) upper view of tibial tunnels.
Figure 2.
Figure 2.
Study flowchart. ACL, anterior cruciate ligament, BTB, bone–patellar tendon–bone .
Figure 3.
Figure 3.
Recovery in the normalized isokinetic peak torque of the knee extensor and flexor in the (A) all-epiphyseal and (B) conventional group. *P < .05 when comparing with preoperatively (Pre op.); † P < .05 when comparing with 3 months after surgery.
See this image and copyright information in PMC

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