‘Over the top’ ACL reconstruction is a safe option for pediatric patients with open physes
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With positive long-term outcomes, an “over the top” ACL reconstruction technique is a safe and feasible treatment strategy for pediatric patients with ACL ruptures and open physes, according to presented results.
“The rupture of the ACL in skeletally immature athletes is progressively becoming an extremely interesting topic,” Valerio Pace, from the Traumatology and Orthopedic Clinic at the University of Perugia in Perugia, Italy, said in his presentation at the Virtual EFORT Congress.
Although it is clear surgical treatment of ACL ruptures is preferred over conservative options, the available evidence does not support any particular technique, Pace said.
“The goal of the surgical procedure is to restore joint stability while avoiding adverse effects on the growth process and damage to the menisci and cartilage,” he added. “The aim of our study is to analyze and evaluate long-term ACL reconstructions (ACLRs) in skeletally immature patients using the ‘over the top’ technique with lateral extra-articular tenodesis in order to highlight its results and complication.”
In their retrospective study, Pace and colleagues included 42 patients (30 male patients and 12 female patients, average age of 12.5 years) with open femoral and tibial physes who underwent ACLR.
Outcome measures included Pedi-IKDC scores, Tegner-Lysholm knee scores, subjective knee forms, arthrometry and return to sports.
At final follow-up (average of 96.1 months), investigators found no instability or leg length discrepancy. The average Tegner-Lysholm score at final follow-up was 94.8 compared with 55 preoperatively. Likewise, the average PEDI-IKDC score at final follow-up was 95.78 compared with 40 preoperatively. Complications occurred in 7.14% of patients, with two re-ruptures and one contralateral ACL rupture reported. In addition, 22 patients returned to pre-injury sport activity, with an average rehabilitation of 7.3 months.
Due to “excellent functional outcomes,” low revision rates and minimal growth disturbances, Pace concluded the “over the top” ACLR technique is a safe treatment option for this pediatric population.
“Our option is a feasible, efficient and safe procedure,” Pace said. “We recommend a more powered study with prospective data collection to provide a higher level of evidence and further validate our results,” he added.
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Pace V, et al. Paper 122. Presented at: Virtual EFORT Congress; Oct. 28-30, 2020.
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