Comparative analysis of arthroscopic techniques of anterior cruciate ligament reconstruction in adolescents

Cover Page

Abstract


Background. According to the considerably contradictory information across the international literature, both the anatomical and transtibial reconstruction of the anterior cruciate ligament (ACL), under similar conditions, yield good functional results from treatment. Therefore, it is important to evaluate the comparative effectiveness and the prospects of certain methods of ACL reconstruction. The purpose of this study was to analyze the possibilities and advantages of anatomical technologies for the reconstruction intervention.

Aim. To compare the outcomes of ACL reconstructions among adolescent children using different methods.

Materials and methods. The outcomes of 94 arthroscopic reconstructions of the ACL in adolescents were analyzed. The patients were categorized into 3 groups: Group 1 included 32 patients (34%) who underwent isometric plastic surgery of the ACL, wherein the femoral canal was formed using the transtibial technique. Group 2 included 30 patients (32%) who underwent anatomical plastic surgery of the ACL, with the formation of the femoral canal through additional anteromedial arthroscopic access. Group 3 included 32 patients (34%) who underwent the “all-inside” anatomical reconstruction of the ACL.

Results. A comparative analysis of the outcomes of reconstruction of the ACL among adolescents revealed that the anterior-posterior and rotational stability of the knee joint was better in group 3 patients than in groups 1 and 2 patients. In fact, the group 3 patients showed a significantly less positive pivot-shift (0 degree to 87.5%; I+ the extent of 12.5%) — than the group 1 patients (0 degree — 46.8%; I+ degree — 25%; II+ degree and 21.9%; III+ degree and 6.3%), followed by the group 2 patients (0 degree to 86.6%; I+ degree 6.7%; II+ degree of 6.7%).

Conclusion. Considering the safety aspects of intra-articular structures and for the better anatomical orientation of the femoral canal, the all-inside method of ACL reconstruction yielded better outcomes of postoperative anterior-posterior and rotational stability of the knee joint.


Full Text

Anterior cruciate ligament (ACL) injury was considered a rare condition in patients with incomplete growth, but recent literature indicated an increasing incidence of this disease. In 2014, Dodwell et al. [1] reported that the incidence of ACL recovery per 100,000 population aged 3 to 20 years in New York increased nearly three times over a 20-year period from 17.6 in 1990 to 50.9 in 2009, and the peak incidence was registered in late adolescence. Many studies have associated the increase in ACL injury incidence with higher activity level during childhood, as well as with earlier sport specialization and fixation on year-round training and competition.

Anatomical risk factors for ACL injury in children include an unexpressed intercondylar fossa, insufficient ACL volume, thickness of the lateral intercondylar ridge, and pronounced posterior tilt of the ACL [2, 3]. In addition, increased quadriceps angle, anteversion, and greater generalized ligamentous laxity are associated with an increased risk of ACL injury. The incidence of ACL injuries is 2–9 times higher in girls than in boys [4–6]. This discrepancy occurs because girls often have the aforementioned anatomical risk factors.

Conservative management of ACL injuries in pediatric patients is associated with 50% dropout of athletes. Numerous studies have shown that the incidence of meniscal tears is higher in pediatric patients who underwent surgery later after ACL injury than in those who were treated immediately after ACL injury [7–9].

Many surgeons worry that surgical treatment may damage the epiphyseal plate and lead to impaired growth and deformities of the limb; therefore, patients and surgeons either choose conservative treatment or postpone ACL reconstruction until growth is complete. However, because nonoperative treatment and delayed ACL reconstruction are associated with worse outcomes [10–14] and surgical methods of ACL reconstruction are constantly improving, an increasing number of surgeons are eager to perform early ACL reconstruction in adolescent patients. One review presented 1867 adolescent patients with functioning growth zones, with history of ACL reconstruction, and without early revision or early reoperation associated with postoperative complications [15].

The risks of damage to the growth zones arising from the drilling of the bone canals during ACL reconstruction are not fully understood. A study has reported that ACL injury may increase the risk of impaired growth regardless of the reconstructive techniques employed [16]. The distal femur and proximal tibia provide more than 60% of the growth of the lower extremity, and they are usually damaged during standard ACL reconstruction with the formation of bone tunnels. The size and orientation of the bone tunnels, as well as the drilling speed, can alter the extent of the damage, and smaller diameters and more vertical tunnels created at slower speeds are more preferable than larger and more inclined tunnels that place the ACL at a biomechanically disadvantageous position [17–20].

Several clinical reports described cases of subsequent leg-length discrepancies or angular deformities after ACL reconstruction in pediatric patients [21–23]. Proponents of transphyseal methods suggest that the formation of bone canals “all-in epiphysis” in the immediate vicinity of the growth zones is more harmful than drilling through a smaller area of the growth zone.

Russian and international literature presents conflicting information, according to which both anatomical and transtibial reconstructions of the ACL, with all other things being equal, can provide good functional results. However, the comparative efficiency and prospects of certain ACL reconstruction methods remain very relevant issues [24]. Moreover, there is a need to analyze the possibilities and advantages of anatomical technologies for ACL reconstruction.

The work aimed to perform a comparative analysis of the results of various ACL reconstruction methods in adolescent patients.

Materials and methods

For this study, the authors analyzed prospectively the results of 94 arthroscopic ACL reconstructions performed in adolescent patients (aged 14–17 years) at the St. Petersburg State Pediatric Medical University in the period from 2015 to 2017.

All patients were distributed into three groups.

In group 1 (n = 32, 34%), isometric ACL grafting was used, in which the femoral canal was created using the transtibial technique. In group 2 (n = 30, 32%), anatomical grafting of the ACL was used with the creation of the femoral canal through an additional anteromedial arthroscopic approach. In group 3 (n = 32, 34%), ACL reconstruction was performed using the “all-inside” anatomical technique (Figs. 1, 2).

 

Fig. 1. Scheme of the surgery, axial view: a, group 1; b, group 2; c, group 3

 

Fig. 2. Scheme of the surgery, frontal view: a, group 1; b, groups 2 and 3.

 

No statistically significant differences were found between the groups in terms of sex, age, mechanism, nature of injuries, duration of injury, and postoperative follow-up (Table 1).

 

Table 1

Comparative characteristics of the study groups (n = 94)

Parameter

Group 1

Group 2

Group 3

ρ

ρ1

ρ2

Количество

32

30

32

   

Средний возраст, лет

15.7 ± 0.94

15.3 ± 0.81

15.3 ± 0.82

>0.05

>0.05

>0.05

Женщины

20 (62.5%)

16 (53.3%)

21 (65.6%)

>0.05

>0.05

>0.05

Мужчины

12 (37.5%)

14 (46.7%)

11 (34.4%)

Спортивная травма

25 (78.1%)

21 (70%)

26 (81.3%)

>0.05

>0.05

>0.05

Бытовая травма

7 (21.9%)

9 (30%)

6 (18.7%)

>0.05

>0.05

>0.05

Note. Here and in other tables, ρ (significance of differences) is the ratio between groups 1 and 2, ρ1 (significance of differences) is the ratio between groups 1 and 3, and ρ2 (significance of differences) is the ratio between groups 2 and 3.

 

The knee joint was assessed through clinical examination (Table 2), radiographic examination, and magnetic resonance imaging, and its function was evaluated using the International Knee Documentation Committee (IKDC) 2000 and Lysholm Knee Scoring Scale. All patients were examined before and after surgery. Clinical and functional results were assessed 12 months after surgery. To assess the knee joint stability, a special KLT Karl Storz instrument was used. The duration of the surgical treatment was also compared in each group.

 

Table 2

Assessment results of the clinical stability of the knee joint before the reconstruction of the anterior cruciate ligament (n = 94)

Degree

Group 1

n = 32

Group 2

n = 30

Group 3

n = 32

Lachman test

0 (0–2 mm)

0

0

0

I+ (3–5 mm)

7 (21.8%)

5 (16.7%)

5 (15.6%)

II+ (6–10 mm)

10 (31.3%)

11 (36.7%)

11 (34.4%)

III+ (>10 mm)

15 (46.9%)

14 (46.6%)

16 (50%)

Anterior drawer test

0 (0–2 mm)

0

0

0

I+ (3–5 mm)

19 (59.4%)

20 (66.7%)

18 (56.3%)

II+ (6–10 mm)

10 (31.3%)

8 (26.7%)

11 (34.3%)

III+ (>10 m)

3 (9.7%)

2 (6.6%)

3 (9.4%)

Pivot-shift test

0 (not determined)

17 (21.9%)

10 (33.3%)

10 (31.3%)

I+ (mild)

11 (34.3%)

10 (33.3%)

11 (34.3%)

II+ (moderate)

10 (31.3%)

8 (26.7%)

8 (25%)

III+ (severe)

4 (12.5%)

2 (6.7%)

3 (9.4%)

 

Results of the clinical study indicating the severity of the anterior–posterior and anterolateral rotational instability of the knee joint prior to ACL reconstruction, obtained using the anterior drawer test, Lachman test, and pivot-shift test in groups 1, 2, and 3, did not differ statistically (p > 0.05).

Surgical treatment of patients was performed according to a standard protocol.

In groups 1 and 2, an autograft was formed from the semitendinous (ST) muscle tendon folded in two, and if the required graft diameter was insufficient, a gracilis tendon (ST + G) was added.

In group 3, an autograft was formed from an ST muscle tendon folded in four. To ensure acceptable ACL strength, the graft diameter was 7.5–8 mm in most cases.

In group 1, the tibial canal was first created. Generally, no difficulties were encountered at this stage, since the point of the canal formation was easily visualized during arthroscopy and was determined both by the preserved distal stump of the native ACL and by the posterior edge of the anterior horn of the lateral meniscus located in the field of view of the arthroscope. After placing the guide wire, the tibial canal was drilled through using a cannulated drill corresponding to the diameter of the graft prepared. The canal was drilled out using the outside-in technique.

In group 1, the femoral canal was created isometrically using the transtibial technique and standard Karl Storz guides with an offset of 7–8–9 mm. The notch located behind the proximal edge of the lateral condyle of the femur, the so-called over-the-top zone, was a reference point when setting the offset of the guide. The canal was drilled out to a graft diameter of 30 mm, and the rest of the canal was formed using a through drill with a diameter of 4.5 mm.

In group 2, the femoral canal was created anatomically through an additional anteromedial approach at the site of ACL attachment. The canal center was slightly displaced to the posterior edge of the lateral condyle of the femur from the center of the lateral bifurcation ridge at a distance equal to the radius of the femoral canal +2.0 mm from the posterior edge of the hyaline cartilage of the lateral condyle of the femur. The canal was created at a 60° angle of flexion in the knee joint, and as in group 1, it had a predetermined diameter and length of 30 mm; the rest of the canal was formed using a through drill with a diameter of 4.5 mm. After the creation of the femoral tunnel, the tibial tunnel was created using the same technique as in group 1.

In group 3, the surgical technique consisted of the creation of bone canals from the joint inside out according to the all-inside reconstruction technique. In this group, the femoral tunnel was created anatomically using a standard femoral guide for this ACL reconstruction technique below the lateral intercondylar ridge, in the middle of the distance between the posterior border of the lateral wall of the intercondylar fossa and the lateral bifurcation ridge. The tibial canal was created in the remnants of the native ACL, opposite the posterior cruciate ligament and laterally from the medial intercondylar spine of the tibia.

In all groups, only suspended extracortical fixators installed at the exit from the created femoral and tibial canals were used. This fixation was selected to reduce aggression on the growth zones and to minimize the frequency of possible epiphysiodesis.

Statistical data analysis was performed using the Statistica 10 package (StatSoft, USA). Descriptive statistical methods were used to display the general characteristics of the baseline parameters, and obtained values are presented as mean ± standard deviation. For variables with normal distribution, group comparisons were performed using Student’s t test. To determine the statistical significance of the differences between the groups, the Mann–Whitney test was used to analyze quantitative variables and Fisher’s exact test was used for nominative ones. The statistical significance of differences in the mean values of the dependent samples was assessed using the paired comparison Wilcoxon test. The p value lower than 0.05 was considered critical.

Results

Comparative analysis of the results of ACL reconstruction in adolescent patients helped establish that the anterior–posterior and rotational stability of the knee joint was higher in group 3 than in groups 1 and 2 (Table 3).

 

Table 3

Analysis results of the clinical stability of the knee joint 12 months after reconstruction of the anterior cruciate ligament (n = 94)

Degree

Group 1

n = 32

Group 2

n = 30

Group 3

n = 32

Lachman test

0 (0–2 mm)

12 (37.5%)

25 (83.3%)

27 (84.4%)

I+ (3–5 mm)

14 (43.7%)

5 (16.7%)

5 (15.6%)

II+ (6–10 mm)

6 (18.8%)

0

0

III+ (>10 mm)

0

0

0

Anterior drawer test

0 (0–2 mm)

22 (68.8%)

24 (80%)

27 (84.4%)

I+ (3–5 mm)

8 (25%)

5 (16.7%)

5 (15.6%)

II+ (6–10 mm)

2 (6.2%)

1 (3.3%)

0

III+ (>10 mm)

0

0

0

Pivot-shift test

0 (not determined)

15 (46.8%)

26 (86.6%)

28 (87.5%)

I+ (mild)

8 (25%)

2 (6.7%)

4 (12.5%)

II+ (moderate)

7 (21.9%)

2 (6.7%)

0

III+ (severe)

2 (6.3%)

0

0

 

The results of the pivot-shift test, indicating the severity of the anterolateral rotational instability, were registered four times more often in group 1 than in groups 2 and 3 (p < 0.0001 and p < 0.0001, respectively). Thus, in group 3, the test results showed 0 degrees in 87.5% of the cases and I+ degree in 12.5%; in group 1, they were 0 degrees in 46.8% of the cases, I+ degree in 25%, II+ degree in 21.9%, and III+ degree in 6.3%; in group 2, they were 0 degrees in 86.6% of the cases, I+ degree in 6.7%, and II+ degree in 6.7%.

The results indicating the severity of the anterior–posterior knee instability after ACL reconstruction, obtained using the anterior drawer and Lachman tests, did not differ statistically significantly in groups 2 and 3 (p > 0.05).

In group 2, the results according to the Lachman test showed 0 degrees in 83.3% of the cases and I+ degree in 16.7%. According to the anterior drawer test, the results were 0 degrees in 80% of the cases, I+ degree in 16.7%, and II+ degree in 3.3%.

In group 3, the results according to the Lachman test were 0 degrees in 84.4% of the cases and I+ degree in 15.6%. According to the anterior drawer test, the results showed 0 degrees in 84.4% and I+ degree in 15.6% of the cases.

Positive results of the anterior drawer test were 1.5 times more often in group 1 than in groups 2 and 3 (0 degrees in 68.8% of the cases, I+ degree in 25.0%, and II+ degree in 6.2%; with p < 0.0001 and p < 0.0001, respectively).

Positive results of the Lachman test in group 1 were four times more often than that in groups 2 and 3 (0 degrees in 37.5% of the patients, I+ degree in 43.7%, and II+ degree in 18.8%), with p < 0.0001 and p < 0.0001, respectively.

In group 3, the results of the functional assessment of the knee joint after ACL reconstruction, according to the IKDC 2000 and Lysholm Knee Scoring Scale, differed significantly from those of groups 2 and 1 for the better (p = 0.00006 and p = 0.00006, respectively) (Table 4).

 

Table 4

Results of group comparison according to the IKDC 2000 and Lysholm Knee Scoring Scale before and after reconstruction of the anterior cruciate ligament (n = 94)

Period

Group 1

n = 32

Group 2

n = 30

Group 3

n = 32

ρ

ρ1

ρ2

IKDC 2000 Scale

Before surgery

56.83 ± 0.86

56.34 ± 0.85

55.77 ± 0.77

>0.05

>0.05

>0.05

After 12 months

85.29 ± 1.09

93.45 ± 0.37

98.48 ± 0.27

0.00006

0.00006

0.00006

Lysholm Knee Scoring Scale

Before surgery

43.94 ± 0.96

44.07 ± 1.03

43.52 ± 0.99

>0.05

>0.05

>0.05

After 12 months

77.0 ± 1.23

85.86 ± 1.45

96.13 ± 0.68

0.00008

0.00006

0.00006

 

The functional results in group 2 were statistically significantly higher than that in group 1 (p = 0.00008 and p = 0.00006 according to the Lysholm Knee Scoring Scale and IKDC 2000, respectively).

At the final stage of the study, the duration of surgery was compared in all groups. In group 2, the surgery took the maximum time (98.2 ± 0.99 min) for better preparation of the joint for the creation of the femoral canal through the additional anteromedial port. Preparation included removal of a part of the fat pad and creation of the femoral canal through an additional anteromedial approach. The additional anteromedial approach should, in turn, be convenient for the creation of the femoral canal and safe for intra-articular structures, in particular for the medial meniscus and hyaline cartilage of the medial femoral condyle. The duration of surgery was the shortest in group 1 (60.03 ± 1.49 min), since all stages were performed using special guides and the installation of which did not cause technical difficulties. In group 3, the surgery duration was an average (72.3 ± 0.76 min) of the indicators in groups 1 and 2 (Table 5).

 

Table 5

Duration of surgery in groups 1, 2, and 3

Group

Duration of surgery (mean value ± standard deviation), min

ρ

ρ1

ρ2

Group 1

60.03 ± 1.49

0.00006

0.00006

0.00006

Group 2

98.2 ± 0.99

Group 3

72.3 ± 0.76

 

Discussion

At present, not only a single priority technique for ACL reconstruction is lacking, but also an ultrastrong graft and an absolutely reliable fixator. Clinics and hospitals worldwide use various techniques for the creation of femoral and tibial canals, all kinds of grafts, and methods of their fixation, but the general principles are dependent on the anatomical nature of the ligament restored, graft isometricity, simplicity, and technical accessibility of the surgical intervention, which ensure maximum safety in the intra- and postoperative periods.

Analysis of the results and contemporary scientific literature present the potential of ACL anatomical reconstruction using the “all-inside” technique and reconstruction using an additional anteromedial access, whose main advantages over the transtibial technique include technical accessibility and reliability in achieving complex stability of the knee joint [25].

According to world literature, the progression of secondary degenerative changes in the knee joint is directly related to the insufficient joint stability after ACL reconstruction [26]. Non-anatomical creation of bone canals leads to the preservation or development of rotational instability; as a result, graft isometry disappears in the postoperative period, which leads to the progression of degenerative changes in the knee joint [27]. The treatment results of group 1 confirm the opinion of leading experts.

Recently, much attention is focused on rare complications associated with ACL reconstruction in patients with incomplete growth. In a review of the Herodicus Society and the ACL study group, Kocher et al. [28] found that 11% of the surgeons reported a growth disorder leading to angular deformities of the lower limbs after ACL reconstruction in adolescent patients. In the present study, majority (80%) of the reported cases of growth impairment occurred on the femoral side, and most cases result in femoral valgus deformities. Kaeding et al. [29] also provide data on the incidence of graft failure (8.2%) after ACL reconstruction in patients aged 10–19 years compared with patients aged 20–29 years (4%) and aged 30–39 years (1.8%).

According to most authors specializing in arthroscopic surgery, early untimely loading, which is a characteristic of young patients striving for early recovery and return to previous sports loads, is the main cause of ACL graft damage and recurrence of knee joint instability. This has nothing in common with the channel formation, graft type, and method of its fixation. The recurrence rate of knee instability in these groups can increase up to 28%. The risk of graft rupture or rupture of the ligament of the opposite joint is 30–40 times higher in adolescents who returned to sports after ACL reconstruction than in healthy adolescents [30].

Moreover, this study revealed that transtibial creation of the femoral canal is simple and safe in terms of the damage to the femoral growth zone, but it also has disadvantages, that is, the point of the femoral canal formation is not anatomically located, which in turn leads to the preservation of rotational instability in the postoperative period, despite the preservation of the graft isometric property.

The creation of the femoral canal through an additional anteromedial approach helped achieve anatomical positioning of the ACL graft and obtain optimal results of knee joint stability. However, this technique involves aggressive resection of a part of Hoffa’s fat pad and the deepest possible flexion of the limb in the knee joint. Even if all stages of surgery are performed, complications associated with damage to the medial meniscus and superficial hyaline cartilage are difficult to avoid completely.

Owing to the safety of intra-articular structures and better anatomical orientation of the femoral canal, the all-inside ACL reconstruction technique helps achieve the best postoperative anterior–posterior and rotational stability of the knee joint. Although the femoral canal was created transphyseally with this ACL reconstruction method, no complications associated with damage to the growth zones (this may be caused by a short follow-up period of 12 months) were recorded in this study. The results obtained are consistent with world data. We believe this offers a number of advantages over other methods.

After ACL reconstruction, up to the incorporation of the graft into the bone canals, joint stability is primarily determined by consistency of the fixators. The close contact of the graft with the canal walls, as well as complete filling of the canals with the graft, contributed to the incorporation. This may occur because with such an arrangement of the ACL graft, the possibility of penetration into the channels of the synovial fluid decreases, and the graft had sufficient contact area with the bone canal walls. These conditions persist only in cases where the bone canals were created using the all-inside ACL reconstruction technique. This reconstruction technique can be recommended for adolescent patients (aged 14–17 years).

Conclusion

The results of the functional assessment of the knee joint 12 months after ACL reconstruction, estimated according to IKDC 2000 (98.48 ± 0.27 in group 3, 93.45 ± 0.37 in group 2, and 85.29 ± 1.09 in group 1) and Lysholm Knee Scoring Scale (96.13 ± 0.68 in group 3, 85.86 ± 1.45 in group 2, and 77.0 ± 1.23 in group 1), differed statistically significantly for the better from the results obtained in groups 2 and 1 (p = 0.00006 and p = 0.00006, respectively). Therefore, the anatomical “all-inside” creation of the femoral and tibial canals, which provides better functional results, should be the preferred approach to the stabilization of the knee joint in adolescent patients.

For ACL reconstruction in adolescent patients, the use of a double or a quadruple ST muscle tendon is recommended. To ensure acceptable ACL strength, the graft diameter must be at least 7.5–8 mm. A significant increase in the graft size can lead to its impingement in the intercondylar fossa of the femur.

When performing surgeries in adolescent patients, the main fixing elements are the extracortical systems to ensure minimal risk of iatrogenic epiphysiodesis.

Additional information

Source of funding. State budget financing was used.

Conflict of interests. The authors declare no conflict of interest.

Ethical statement. The study was conducted in accordance with the ethical standards of the Declaration of Helsinki of the World Medical Association as amended by the Ministry of Health of Russia and approved by the ethical committee of the R.R. Vreden Russian Scientific Research Institute of Traumatology and Orthopedics (protocol No. 17/1 dated 10/11/2018). Patient representatives signed informed consent to participate in the study and publish the data without identification of personality.

Author contributions

M.R. Salikhov developed the concept and design of the article, collected the literature data and the clinical material, analyzed and interpreted the data obtained, and edited the text.

V.V. Avramenko collected literature data and clinical material, edited the text, and coordinated with the research participants.

All authors have made a significant contribution to the research and preparation of the article and have read and approved the final version before its publication.

About the authors

Marsel R. Salikhov

Vreden National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: virus-007-85@mail.ru
ORCID iD: 0000-0002-5706-481X

Russian Federation, Saint Petersburg

MD, PhD, Assistant Researcher

Vladislav V. Avramenko

Saint Petersburg State Pediatric Medical University

Email: avramenko.spb@mail.ru
ORCID iD: 0000-0003-0339-6066

Russian Federation, Saint Petersburg

MD, Head of the Department of Traumatology and Orthopedics

References

  1. Dodwell ER, Lamont LE, Green DW, et al. 20 years of pediatric anterior cruciate ligament reconstruction in New York State. Am J Sports Med. 2014;42(3):675-680. https://doi.org/10.1177/0363546513518412.
  2. Whitney DC, Sturnick DR, Vacek PM, et al. Relationship between the risk of suffering a first-time noncontact ACL injury and geometry of the femoral notch and ACL: A prospective cohort study with a nested case-control analysis. Am J Sports Med. 2014;42(8):1796-1805. https://doi.org/10.1177/0363546514534182.
  3. Myer GD, Ford KR, Di Stasi SL, et al. High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: Is PFP itself a predictor for subsequent ACL injury? Br J Sports Med. 2015;49(2):118-122. https://doi.org/10.1136/bjsports-2013-092536.
  4. Walden M, Krosshaug T, Bjorneboe J, et al. Three distinct mechanisms predominate in non-contact anterior cruciate ligament injuries in male professional football players: A systematic video analysis of 39 cases. Br J Sports Med. 2015;49(22):1452-1460. https://doi.org/10.1136/bjsports-2014-094573.
  5. Devetag F, Mazzilli M, Benis R, et al. Anterior cruciate ligament injury profile in Italian Serie A1-A2 women’s volleyball league. J Sports Med Phys Fitness. 2018;58(1-2):92-97. https://doi.org/10.23736/S0022-4707.16.06731-1.
  6. Takahashi S, Nagano Y, Ito W, et al. A retrospective study of mechanisms of anterior cruciate ligament injuries in high school basketball, handball, judo, soccer, and volleyball. Medicine (Baltimore). 2019;98(26):e16030. https://doi.org/10.1097/MD.0000000000016030.
  7. Guenther ZD, Swami V, Dhillon SS, Jaremko JL. Meniscal injury after adolescent anterior cruciate ligament injury: How long are patients at risk? Clin Orthop Relat Res. 2014;472(3):990-997. https://doi.org/10.1007/s11999-013-3369-9.
  8. Brambilla L, Pulici L, Carimati G, et al. Prevalence of associated lesions in anterior cruciate ligament reconstruction: Correlation with surgical timing and with patient age, sex, and body mass index. Am J Sports Med. 2015;43(12):2966-2973. https://doi.org/10.1177/0363546515608483.
  9. Stone JA, Perrone GS, Nezwek TA, et al. Delayed ACL reconstruction in patients >/=40 years of age is associated with increased risk of medial meniscal injury at 1 year. Am J Sports Med. 2019;47(3):584-589. https://doi.org/10.1177/0363546518817749.
  10. Frank JS, Gambacorta PL. Anterior cruciate ligament injuries in the skeletally immature athlete: Diagnosis and management. J Am Acad Orthop Surg. 2013;21(2):78-87. https://doi.org/10.5435/JAAOS-21-02-78.
  11. Fabricant PD, Jones KJ, Delos D, et al. Reconstruction of the anterior cruciate ligament in the skeletally immature athlete: A review of current concepts: AAOS exhibit selection. J Bone Joint Surg Am. 2013;95(5):e28. https://doi.org/10.2106/JBJS.L.00772.
  12. Funahashi KM, Moksnes H, Maletis GB, et al. Anterior cruciate ligament injuries in adolescents with open physis: Effect of recurrent injury and surgical delay on meniscal and cartilage injuries. Am J Sports Med. 2014;42(5):1068-1073. https://doi.org/ 10.1177/0363546514525584.
  13. Ramski DE, Kanj WW, Franklin CC, et al. Anterior cruciate ligament tears in children and adolescents: A meta-analysis of nonoperative versus operative treatment. Am J Sports Med. 2014;42(11):2769-2776. https://doi.org/10.1177/0363546513510889.
  14. Crawford EA, Young LJ, Bedi A, Wojtys EM. The effects of delays in diagnosis and surgical reconstruction of ACL tears in skeletally immature individuals on subsequent meniscal and chondral injury. J Pediatr Orthop. 2019;39(2):55-58. https://doi.org/10.1097/BPO.0000000000000960.
  15. Csintalan RP, Inacio MC, Desmond JL, Funahashi TT. Anterior cruciate ligament reconstruction in patients with open physes: Early outcomes. J Knee Surg. 2013;26(4):225-232. https://doi.org/ 10.1055/s-0032-1329235.
  16. Shifflett GD, Green DW, Widmann RF, Marx RG. Growth arrest following ACL reconstruction with hamstring autograft in skeletally immature patients: A review of 4 cases. J Pediatr Orthop. 2016;36(4):355-361. https://doi.org/10.1097/BPO.0000000000000466.
  17. Calvo R, Figueroa D, Gili F, et al. Transphyseal anterior cruciate ligament reconstruction in patients with open physes: 10-year follow-up study. Am J Sports Med. 2015;43(2):289-294. https://doi.org/10.1177/0363546514557939.
  18. Kohl S, Stutz C, Decker S, et al. Mid-term results of transphyseal anterior cruciate ligament reconstruction in children and adolescents. Knee. 2014;21(1):80-85. https://doi.org/10.1016/j.knee.2013.07.004.
  19. Keller TC, Tompkins M, Economopoulos K, et al. Tibial tunnel placement accuracy during anterior cruciate ligament reconstruction: Independent femoral versus transtibial femoral tunnel drilling techniques. Arthroscopy. 2014;30(9):1116-1123. https://doi.org/10.1016/ j.arthro.2014.04.004.
  20. Cruz AI, Jr., Lakomkin N, Fabricant PD, Lawrence JT. Transphyseal ACL reconstruction in skeletally immature patients: Does independent femoral tunnel drilling place the physis at greater risk compared with transtibial drilling? Orthop J Sports Med. 2016;4(6):2325967116650432. https://doi.org/10.1177/2325967116650432.
  21. Nawabi DH, Jones KJ, Lurie B, et al. All-inside, physeal-sparing anterior cruciate ligament reconstruction does not significantly compromise the physis in skeletally immature athletes: A postoperative physeal magnetic resonance imaging analysis. Am J Sports Med. 2014;42(12):2933-2940. https://doi.org/10.1177/0363546514552994.
  22. Kachmar M, Piazza SJ, Bader DA. Comparison of growth plate violations for transtibial and anteromedial surgical techniques in simulated adolescent anterior cruciate ligament reconstruction. Am J Sports Med. 2016;44(2):417-424. https://doi.org/10.1177/0363546515619624.
  23. Osier CJ, Espinoza-Ervin C, Diaz De Leon A, et al. A comparison of distal femoral physeal defect and fixation position between two different drilling techniques for transphyseal anterior cruciate ligament reconstruction. J Pediatr Orthop B. 2015;24(2):106-113. https://doi.org/10.1097/BPB.0000000000000143.
  24. Ha JK, Lee DW, Kim JG. Single-bundle versus double-bundle anterior cruciate ligament reconstruction: A comparative study with propensity score matching. Indian J Orthop. 2016;50(5):505-511. https://doi.org/10.4103/0019-5413.189605.
  25. Rayan F, Nanjayan SK, Quah C, et al. Review of evolution of tunnel position in anterior cruciate ligament reconstruction. World J Orthop. 2015;6(2):252-262. https://doi.org/10.5312/wjo.v6.i2.252.
  26. Arnold MP, Duthon V, Neyret P, Hirschmann MT. Double incision iso-anatomical ACL reconstruction: The freedom to place the femoral tunnel within the anatomical attachment site without exception. Int Orthop. 2013;37(2):247-251. https://doi.org/10.1007/s00264-012-1681-8.
  27. Robin BN, Jani SS, Marvil SC, et al. Advantages and disadvantages of transtibial, anteromedial portal, and outside-in femoral tunnel drilling in single-bundle anterior cruciate ligament reconstruction: A systematic review. Arthroscopy. 2015;31(7):1412-1417. https://doi.org/10.1016/j.arthro.2015.01.018.
  28. Kocher MS, Saxon HS, Hovis WD, Hawkins RJ. Management and complications of anterior cruciate ligament injuries in skeletally immature patients: Survey of the Herodicus Society and the ACL study group. J Pediatr Orthop. 2002;22(4):452-457.
  29. Kaeding CC, Aros B, Pedroza A, et al. Allograft versus autograft anterior cruciate ligament reconstruction: Predictors of failure from a MOON Prospective Longitudinal Cohort. Sports Health. 2011;3(1):73-81. https://doi.org/10.1177/1941738110386185.
  30. Wiggins AJ, Grandhi RK, Schneider DK, et al. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: A systematic review and meta-analysis. Am J Sports Med. 2016;44(7):1861-1876. https://doi.org/10.1177/0363546515621554.

Supplementary files

Supplementary Files Action
1.
Fig. 1. Scheme of the surgery, axial view: a, group 1; b, group 2; c, group 3

Download (147KB) Indexing metadata
2.
Fig. 2. Scheme of the surgery, frontal view: a, group 1; b, groups 2 and 3.

Download (160KB) Indexing metadata

Statistics

Views

Abstract - 127

PDF (Russian) - 31

PDF (English) - 4

PDF (简体中文) - 1

Cited-By


Article Metrics

Metrics Loading ...

PlumX

Dimensions


Copyright (c) 2020 Salikhov M.R., Avramenko V.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies