A randomized trial on transphyseal vs. physeal-sparing reconstruction in skeletally immature patients: functional outcomes and safety considerations

Submitted: 9 October 2024
Accepted: 24 October 2024
Published: 6 December 2024
Abstract Views: 37
PDF: 9
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Reconstruction of the Anterior Cruciate Ligament (ACL) in Skeletally Immature Patients (SIP) poses challenges due to anatomical and developmental factors. This randomized controlled trial evaluated the Functional Recovery (FR) of pediatric patients undergoing ACL Reconstruction (ACLR), comparing Transphyseal Reconstruction (TPR) and physeal-sparing reconstruction (PSR). Forty-three young athletes (mean age 14.1 ± 2.3 years), including 29 boys and 14 girls, were randomized to TPR (n=23) or PSR (n=20). FR was assessed by using the Pediatric International Knee Documentation Committee (Pedi-IKDC) questionnaire at baseline, 8 months, and 12 months post-surgery. At the 12-month follow-up, the TPR group demonstrated a significantly greater improvement in Pedi-IKDC scores, with a 66.95% increase compared to 56.73% in the PSR group, reflecting notable differences in knee function between the groups at both 8 and 12 months (p < 0.001). Additionally, 80% of participants in the TPR group returned to sports, with 56% resuming limited activities, while the PSR group exhibited a slower recovery trajectory. These preliminary findings indicate that TPR provides superior FR and a faster return to sports compared to PSR, underscoring the importance of tailored rehabilitation protocols and long-term follow-up to optimize outcomes in SIP.

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Rechel JA, Collins CL, Comstock RD. Epidemiology of injuries requiring surgery among high school athletes in the United States, 2005 to 2010. J Trauma 2011; 71:982-9. DOI: https://doi.org/10.1097/TA.0b013e318230e716
Swenson DM, Collins CL, Best TM, et al. Epidemiology of knee injuries among U.S. high school athletes, 2005/2006-2010/2011. Med Sci Sports Exerc 2013; 45:462-9. DOI: https://doi.org/10.1249/MSS.0b013e318277acca
Joseph AM, Collins CL, Henke NM, et al. A multisport epidemiologic comparison of anterior cruciate ligament injuries in high school athletics. J Athl Train 2013; 48:810-7. DOI: https://doi.org/10.4085/1062-6050-48.6.03
Willson RG, Kostyun RO, Milewski MD, Nissen CW. Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: Early Results Using a Hybrid Physeal-Sparing Technique. Orthop J Sports Med 2018; 6:2325967118755330. DOI: https://doi.org/10.1177/2325967118755330
Gausden EB, Calcei JG, Fabricant PD, Green DW. Surgical options for anterior cruciate ligament reconstruction in the young child. Curr Opin Pediatr 2015; 27:82-91. DOI: https://doi.org/10.1097/MOP.0000000000000174
Cancino B, Muñoz C, Tuca MJ, et al. Anterior Cruciate Ligament Rupture in Skeletally Immature Patients. J Am Acad Orthop Surg Glob Res Rev 2022; 6:e21.00166. DOI: https://doi.org/10.5435/JAAOSGlobal-D-21-00166
DeFrancesco CJ, Storey EP, Shea KG, et al. Challenges in the management of anterior cruciate ligament ruptures in skeletally immature patients. Instr Course Lect 2018; 67:391-402. DOI: https://doi.org/10.5435/JAAOS-D-17-00294
van Melick N, van Cingel RE, Brooijmans F, et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med 2016;50:1506-15.
Dragicevic-Cvjetkovic D, Jandric S, Bijeljac S, et al. The effects of rehabilitation protocol on functional recovery after anterior cruciate ligament reconstruction. Med Arch 2014; 68:350-2. DOI: https://doi.org/10.5455/medarh.2014.68.350-352
Leonardi M, Lee H, Kostanjsek N, et al. 20 Years of ICF-International Classification of Functioning, Disability and Health: Uses and Applications around the World. Int J Environ Res Public Health 2022; 19:11321. DOI: https://doi.org/10.3390/ijerph191811321
Yellin JL, Fabricant PD, Gornitzky A, et al. Rehabilitation following anterior cruciate ligament tears in children: a systematic review. JBJS Rev 2016; 4:e4. DOI: https://doi.org/10.2106/JBJS.RVW.O.00001
Ptasinski AM, Dunleavy M, Adebayo T, Gallo RA. Returning athletes to sports following anterior cruciate ligament tears. Curr Rev Musculoskelet Med 2022; 15:616-28. DOI: https://doi.org/10.1007/s12178-022-09782-3
Rodriguez K, Soni M, Joshi PK, et al. Anterior cruciate ligament injury: conservative versus surgical treatment. Cureus 2021; 13:e20206. DOI: https://doi.org/10.7759/cureus.20206
Petersen W, Bierke S, Stöhr A, et al. A systematic review of transphyseal ACL reconstruction in children and adolescents: comparing the transtibial and independent femoral tunnel drilling techniques. J Exp Orthop 2023; 10:7. DOI: https://doi.org/10.1186/s40634-023-00577-0
Research randomizer. Accessed January 17, 2023. Available from: https://www.randomizer.org/
Deviandri R, van der Veen HC, Lubis AMT, et al. Cost-effectiveness of ACL treatment is dependent on age and activity level: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:530-41. Erratum in: Knee Surg Sports Traumatol Arthrosc 2023; 31:542. DOI: https://doi.org/10.1007/s00167-022-07087-z
Moksnes H, Engebretsen L, Risberg MA. Management of anterior cruciate ligament injuries in skeletally immature individuals. J Orthop Sports Phys Ther 2012; 42:172-83. DOI: https://doi.org/10.2519/jospt.2012.3608
Saki F, Shafiee H, Tahayori B, Ramezani F. The effects of core stabilization exercises on the neuromuscular function of athletes with ACL reconstruction. Sci Rep 2023; 13:2202. DOI: https://doi.org/10.1038/s41598-023-29126-6
Logerstedt D, Grindem H, Lynch A, et al. Single-legged hop tests as predictors of self-reported knee function after anterior cruciate ligament reconstruction: the Delaware-Oslo ACL cohort study. Am J Sports Med 2012; 40:2348-56? DOI: https://doi.org/10.1177/0363546512457551
Grindem H, Granan LP, Risberg MA, et al. How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry. Br J Sports Med 2015;49:385-9. DOI: https://doi.org/10.1136/bjsports-2014-093891
Nasreddine AY, Connell PL, Kalish LA, et al. The Pediatric International Knee Documentation Committee (Pedi-IKDC) Subjective Knee Evaluation Form: Normative Data. Am J Sports Med 2017;45:527-34. DOI: https://doi.org/10.1177/0363546516672456
Frosch KH, Stengel D, Brodhun T, et al. Outcomes and risks of operative treatment of rupture of the anterior cruciate ligament in children and adolescents. Arthroscopy 2010;26:1539-50. DOI: https://doi.org/10.1016/j.arthro.2010.04.077
Kocher MS, Smith JT, Zoric BJ, et al. Transphyseal anterior cruciate ligament reconstruction in skeletally immature pubescent adolescents. J Bone Joint Surg Am 2007;89:2632-9. DOI: https://doi.org/10.2106/JBJS.F.01560
Guzzanti V, Falciglia F, Stanitski CL. Preoperative evaluation and anterior cruciate ligament reconstruction technique for skeletally immature patients in Tanner stages 2 and 3. Am J Sports Med 2003;31:941-8. DOI: https://doi.org/10.1177/03635465030310063301
Kocher MS, Heyworth BE, Fabricant PD, et al. Outcomes of Physeal-Sparing ACL Reconstruction with Iliotibial Band Autograft in Skeletally Immature Prepubescent Children. J Bone Joint Surg Am 2018;100:1087-94. DOI: https://doi.org/10.2106/JBJS.17.01327
Jenkins SM, Guzman A, Gardner BB, et al. Rehabilitation after anterior cruciate ligament injury: review of current literature and recommendations. Curr Rev Musculoskelet Med 2022;15:170-9. DOI: https://doi.org/10.1007/s12178-022-09752-9
van Melick N, van Cingel RE, Brooijmans F, et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med 2016;50:1506-15. DOI: https://doi.org/10.1136/bjsports-2015-095898
Moksnes H, Grindem H. Prevention and rehabilitation of paediatric anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 2016;24:730-6. DOI: https://doi.org/10.1007/s00167-015-3856-5
Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 2011;45:596-606. DOI: https://doi.org/10.1136/bjsm.2010.076364
Risberg MA, Holm I. The long-term effect of 2 postoperative rehabilitation programs after anterior cruciate ligament reconstruction: a randomized controlled clinical trial with 2 years of follow-up. Am J Sports Med 2009; 37:1958-66. DOI: https://doi.org/10.1177/0363546509335196

How to Cite

Stefanov, V., Tzachev , N., Simeonov , M., Milanova , H., Obretenov, V., Panayotov , K., Angelova , A., & Papathanasiou, J. (2024). A randomized trial on transphyseal vs. physeal-sparing reconstruction in skeletally immature patients: functional outcomes and safety considerations. European Journal of Translational Myology. https://doi.org/10.4081/ejtm.2024.13221