Cargando…

The Risk of Transphyseal Drilling in Skeletally Immature Patients With Anterior Cruciate Ligament Injury

BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) in skeletally immature patients can result in growth plate injury, which can cause growth disturbances. PURPOSE: To evaluate radiological tibial and femoral length and axis growth disturbances as well as clinical outcomes in skeletally imm...

Descripción completa

Detalles Bibliográficos
Autores principales: Faunø, Peter, Rømer, Lone, Nielsen, Torsten, Lind, Martin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2016
Materias:
25
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015702/
https://www.ncbi.nlm.nih.gov/pubmed/27648453
http://dx.doi.org/10.1177/2325967116664685
_version_ 1782452482237005824
author Faunø, Peter
Rømer, Lone
Nielsen, Torsten
Lind, Martin
author_facet Faunø, Peter
Rømer, Lone
Nielsen, Torsten
Lind, Martin
author_sort Faunø, Peter
collection PubMed
description BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) in skeletally immature patients can result in growth plate injury, which can cause growth disturbances. PURPOSE: To evaluate radiological tibial and femoral length and axis growth disturbances as well as clinical outcomes in skeletally immature ACLR patients treated with a transphyseal drilling technique. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 39 pediatric patients with ACL injury and open physes at time of surgery, as diagnosed clinically and with magnetic resonance imaging (MRI), were treated using transphyseal ACLR using hamstring graft. Mean patient age was 11.7 years (range, 9.0-14.0 years). Patients were evaluated with full extremity radiographs measuring leg length discrepancy and malalignment, as well as clinical evaluation with KT-1000 arthrometer measurements and Tegner activity scale and Knee injury and Osteoarthritis Outcome Score (KOOS) outcomes after follow-up of 68 months (range, 29-148 months). RESULTS: Of the 39 initial patients, 33 were evaluated both clinically and radiographically. We found a mean femoral length shortening of 3.5 mm (P = .01) on the operated leg. Eight patients (24%) had a more than 10-mm shortening of the operated leg, whereas only 1 patient (3%) had a 10-mm shortening of the nonoperated leg. In 27 of 33 patients (82%; P < .001), the anatomic femoral axes of the operated leg were found to be more than 2° of valgus compared with the nonoperated leg. The tibial anatomic axes changed into a less pronounced varus angulation (P = .02). The femoral-tibial anatomic axes were not significantly different when comparing the 2 legs. We did not find any statistical difference in growth arrest comparing patients treated surgically at the ages of 13 to 14 years to patients younger than 13 years. Tegner and KOOS scores were significantly lower among girls compared with boys. Side-to-side KT-1000 arthrometer difference improved from 5.2 mm preoperatively to 1.6 mm at follow-up. CONCLUSION: This study shows that transphyseal ACLR in children results in minor length growth disturbances in 24% of patients. The surgically induced distal femoral valgus angulation is counterbalanced by a proximal tibial varus angulation. Growth disturbance after surgery is not associated with a certain pediatric age group. Otherwise, transphyseal ACLR has satisfactory clinical outcomes, with good subjective outcomes, function level, and knee stability.
format Online
Article
Text
id pubmed-5015702
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-50157022016-09-19 The Risk of Transphyseal Drilling in Skeletally Immature Patients With Anterior Cruciate Ligament Injury Faunø, Peter Rømer, Lone Nielsen, Torsten Lind, Martin Orthop J Sports Med 25 BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) in skeletally immature patients can result in growth plate injury, which can cause growth disturbances. PURPOSE: To evaluate radiological tibial and femoral length and axis growth disturbances as well as clinical outcomes in skeletally immature ACLR patients treated with a transphyseal drilling technique. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 39 pediatric patients with ACL injury and open physes at time of surgery, as diagnosed clinically and with magnetic resonance imaging (MRI), were treated using transphyseal ACLR using hamstring graft. Mean patient age was 11.7 years (range, 9.0-14.0 years). Patients were evaluated with full extremity radiographs measuring leg length discrepancy and malalignment, as well as clinical evaluation with KT-1000 arthrometer measurements and Tegner activity scale and Knee injury and Osteoarthritis Outcome Score (KOOS) outcomes after follow-up of 68 months (range, 29-148 months). RESULTS: Of the 39 initial patients, 33 were evaluated both clinically and radiographically. We found a mean femoral length shortening of 3.5 mm (P = .01) on the operated leg. Eight patients (24%) had a more than 10-mm shortening of the operated leg, whereas only 1 patient (3%) had a 10-mm shortening of the nonoperated leg. In 27 of 33 patients (82%; P < .001), the anatomic femoral axes of the operated leg were found to be more than 2° of valgus compared with the nonoperated leg. The tibial anatomic axes changed into a less pronounced varus angulation (P = .02). The femoral-tibial anatomic axes were not significantly different when comparing the 2 legs. We did not find any statistical difference in growth arrest comparing patients treated surgically at the ages of 13 to 14 years to patients younger than 13 years. Tegner and KOOS scores were significantly lower among girls compared with boys. Side-to-side KT-1000 arthrometer difference improved from 5.2 mm preoperatively to 1.6 mm at follow-up. CONCLUSION: This study shows that transphyseal ACLR in children results in minor length growth disturbances in 24% of patients. The surgically induced distal femoral valgus angulation is counterbalanced by a proximal tibial varus angulation. Growth disturbance after surgery is not associated with a certain pediatric age group. Otherwise, transphyseal ACLR has satisfactory clinical outcomes, with good subjective outcomes, function level, and knee stability. SAGE Publications 2016-09-06 /pmc/articles/PMC5015702/ /pubmed/27648453 http://dx.doi.org/10.1177/2325967116664685 Text en © The Author(s) 2016 http://creativecommons.org/licenses/by-nc-nd/3.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License (http://www.creativecommons.org/licenses/by-nc-nd/3.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle 25
Faunø, Peter
Rømer, Lone
Nielsen, Torsten
Lind, Martin
The Risk of Transphyseal Drilling in Skeletally Immature Patients With Anterior Cruciate Ligament Injury
title The Risk of Transphyseal Drilling in Skeletally Immature Patients With Anterior Cruciate Ligament Injury
title_full The Risk of Transphyseal Drilling in Skeletally Immature Patients With Anterior Cruciate Ligament Injury
title_fullStr The Risk of Transphyseal Drilling in Skeletally Immature Patients With Anterior Cruciate Ligament Injury
title_full_unstemmed The Risk of Transphyseal Drilling in Skeletally Immature Patients With Anterior Cruciate Ligament Injury
title_short The Risk of Transphyseal Drilling in Skeletally Immature Patients With Anterior Cruciate Ligament Injury
title_sort risk of transphyseal drilling in skeletally immature patients with anterior cruciate ligament injury
topic 25
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015702/
https://www.ncbi.nlm.nih.gov/pubmed/27648453
http://dx.doi.org/10.1177/2325967116664685
work_keys_str_mv AT faunøpeter theriskoftransphysealdrillinginskeletallyimmaturepatientswithanteriorcruciateligamentinjury
AT rømerlone theriskoftransphysealdrillinginskeletallyimmaturepatientswithanteriorcruciateligamentinjury
AT nielsentorsten theriskoftransphysealdrillinginskeletallyimmaturepatientswithanteriorcruciateligamentinjury
AT lindmartin theriskoftransphysealdrillinginskeletallyimmaturepatientswithanteriorcruciateligamentinjury
AT faunøpeter riskoftransphysealdrillinginskeletallyimmaturepatientswithanteriorcruciateligamentinjury
AT rømerlone riskoftransphysealdrillinginskeletallyimmaturepatientswithanteriorcruciateligamentinjury
AT nielsentorsten riskoftransphysealdrillinginskeletallyimmaturepatientswithanteriorcruciateligamentinjury
AT lindmartin riskoftransphysealdrillinginskeletallyimmaturepatientswithanteriorcruciateligamentinjury