Transphyseal anterior cruciate ligament reconstruction in patients with open physes

Arthroscopy. 2009 Aug;25(8):831-8. doi: 10.1016/j.arthro.2009.01.015.


Purpose: The purpose of this study was to evaluate the clinical outcomes of transphyseal anterior cruciate ligament (ACL) reconstruction in patients with open physes.

Methods: Transphyseal ACL reconstruction was performed in 26 patients with open tibial and femoral physes (physis >2 mm) by use of autogenous quadrupled hamstrings as grafts. Meniscal tearing was found in 65.3% of the patients. Partial chondral defect injury on the medial femoral condyle was found 6 months after injury in only 2 patients (7.69% of all patients). The mean follow-up period was 45 +/- 18.3 months. Clinical outcomes were evaluated by use of the International Knee Documentation Committee score and Lysholm Knee Scoring Scale, and the anteroposterior stability was objectively measured by use of KT-1000 arthrometer (MEDmetric, San Diego, CA). Possible length and angular discrepancies were observed by conventional radiography in a long film and scanograms of the lower limbs.

Results: The mean length discrepancy between the operated lower limb and the contralateral limb was 1.2 +/- 3.2 mm (range, -7 to 7 mm). The mean angular deviation difference between the lower limbs was 0.46 degrees +/- 1.1 degrees . New traumatic injuries developed in 3 patients, in whom surgical revision was performed; 1 patient underwent a late meniscectomy. The mean difference in KT-1000 measurement was 2.0 +/- 1.0 mm. The mean subjective International Knee Documentation Committee score was 91.5 +/- 5.7, and the mean score on the modified Lysholm scale was 93.5 +/- 4. Of the patients, 3 (11.2% of all patients) could not return to the same level of physical activity as before injury.

Conclusions: ACL reconstruction by use of the transphyseal technique in an immature skeleton with a hamstring autograft, with careful attention being paid to the technique, resulted in good clinical outcomes and no growth abnormalities.

Level of evidence: Level IV, therapeutic case series.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Anterior Cruciate Ligament / diagnostic imaging
  • Anterior Cruciate Ligament / surgery*
  • Child
  • Epiphyses / diagnostic imaging
  • Female
  • Femur / diagnostic imaging
  • Follow-Up Studies
  • Growth Plate / diagnostic imaging*
  • Growth Plate / growth & development
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Menisci, Tibial / diagnostic imaging
  • Menisci, Tibial / surgery
  • Plastic Surgery Procedures / methods*
  • Plastic Surgery Procedures / statistics & numerical data
  • Radiography
  • Recovery of Function
  • Retrospective Studies
  • Tendons / transplantation
  • Tibia / diagnostic imaging
  • Tibial Meniscus Injuries
  • Transplantation, Autologous
  • Treatment Outcome