Transphyseal anterior cruciate ligament reconstruction using living parental donor hamstring graft: excellent clinical r
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Transphyseal anterior cruciate ligament reconstruction using living parental donor hamstring graft: excellent clinical results at 2 years in a cohort of 100 patients Koushik Ghosh1 · Lucy J. Salmon1 · Emma Heath1 · Leo A. Pinczewski1,2 · Justin P. Roe1 Received: 16 June 2019 / Accepted: 19 December 2019 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose To determine outcomes of transphyseal ACL reconstruction using a living parental hamstring tendon allograft in a consecutive series of 100 children. Methods One hundred consecutive juveniles undergoing ACL reconstruction with a living parental hamstring allograft were recruited prospectively and reviewed 2 years after ACL reconstruction with IKDC Knee Ligament Evaluation, and KT1000 instrumented laxity testing. Skeletally immature participants obtained annual radiographs until skeletal maturity, and long leg alignment radiographs at 2 years. Radiographic Posterior tibial slope was recorded. Results Of 100 juveniles, the median age was 14 years (range 8–16) and 68% male. At surgery, 30 juveniles were graded Tanner 1 or 2, 21 were Tanner 3 and 49 were Tanner 4 or 5. There were no cases of iatrogenic physeal injury or leg length discrepancy on long leg radiographs at 2 years, despite a median increase in height of 8 cm. Twelve patients had an ACL graft rupture and 9 had a contralateral ACL injury. Of those without further ACL injury, 82% returned to competitive sports, IKDC ligament evaluation was normal in 52% and nearly normal in 48%. The median side to side difference on manual maximum testing with the KT1000 was 2 mm (range − 1 to 5). A radiographic PTS of 12° or more was observed in 49%. Conclusions ACL reconstruction in the juvenile with living parental hamstring tendon allograft is a viable procedure associated with excellent clinical stability, patient-reported outcomes and return to sport over 2 years. Further ACL injury to the reconstructed and the contralateral knee remains a significant risk, with identical prevalence observed between the reconstructed and contralateral ACL between 12 and 24 months after surgery. Level of evidence III (Cohort Study). Keywords Juvenile · Anterior cruciate ligament · Paediatric · Reconstruction · Rupture · Reinjury
Introduction Anterior cruciate ligament (ACL) injury is occurring with increasing frequency amongst juveniles [33, 34, 42, 44]. The natural sequelae of ACL deficiency in children are recurrent instability leading to chondral and meniscal damage [2, 16]. Reconstruction in juveniles is, therefore, the preference, however, this has been shown to be associated with a * Lucy J. Salmon [email protected] 1
North Sydney Orthopaedic and Sports Medicine Centre, The Mater Clinic, Suite 2, 3 Gillies St., Wollstonecraft, NSW 2065, Australia
University of Notre Dame, Sydney, Australia
2
2.5–5 times greater risk of ACL graft re-rupture compared to adults [32]. Furthermore, repeat ACL injury is reported to occur in 22–30% in the first 5 years after ACL r
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