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Preoperative Evaluation and Anterior Cruciate Ligament Reconstruction Technique for Skeletally Immature Patients in Tanner Stages 2 and 3

From the Orthopaedic Department, the Children’s Hospital Bambino Gesù, Rome, Italy

^* Address correspondence and reprint requests to Prof. Vincenzo Guzzanti, MD, Children’s Hospital Bambino Gesù, Orthopaedic Department, Piazza S. Onofrio 4, 00165 Rome, Italy

Background: Transphyseal anterior cruciate ligament reconstruction in skeletally immature patients carries the risk of adverse sequelae.

Purpose: 1) To provide clinical and radiographic methods to identify skeletally immature patients with significant remaining lower limb growth. 2) To provide a method for calculating the percent area lesion created by a 6-mm distal femoral physeal tunnel. 3) To present a method of partial transphyseal intraarticular anterior cruciate ligament reconstruction with bipolar graft fixation in these patients. 4) To report on clinical, functional, and radiographic results at skeletal maturity.

Methods: Fourteen adolescents with symptomatic anterior cruciate ligament instability who were identified as being in Tanner stages 2 and 3 underwent partial transphyseal intraarticular anterior cruciate ligament reconstruction with the use of hamstring tendon grafts (transphyseal only in the femur and through the epiphysis in the tibia).

Results: At skeletal maturity, 10 patients were asymptomatic and fully active in sports. No patient had significant leg-length inequality or angular deformity after use of a 6-mm femoral physeal tunnel, which represented 1) less than 7% of the frontal plane and 2) less than 1% of the transverse plane cross-sectional femoral physeal areas.

Conclusions: The choice of the exposed technique and the method used to select patients permitted us to avoid adverse sequelae.

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