Top

Published in:

01-04-2020 | Original Paper

Over the top anterior cruciate ligament reconstruction in patients with open physes: a long-term follow-up study

Authors: Riccardo Maria Lanzetti, Valerio Pace, Alessandro Ciompi, Dario Perugia, Marco Spoliti, Francesco Falez, Caraffa Auro

Published in: International Orthopaedics | Issue 4/2020

Abstract

Introduction

Anterior cruciate ligament (ACL) rupture in skeletally immature athletes is becoming an injury with increasing incidence. Choices of treatment are still debated, including conservative management vs. various surgical techniques. The lack of long-term reports has been highlighted in the literature. Aim: To evaluate long-term results of ACL reconstructions performed in skeletally immature patients using the Over the Top technique with lateral extra-articular tenodesis.

Methods

Retrospective study. All surgeries performed by same surgeon. A total of 42 patients included. All patients had pre-operative radiological studies. Subjects: 30 males and 12 females. Average age: 12.5 years (range 11–14 years). Average follow-up: 96.1 months. Clinical evaluation: Pedi-IKDC, Tegner-Lysholm, KT-1000 and plain radiographs. Standardized rehabilitation protocol.

Results

No instability or leg length discrepancy was recorded. Average pre-operative Tegner-Lysholm and Pedi-IKDC scores were 55 and 40, respectively, with a score of 94.8 (p < 0.05) and 94.78, respectively, at final follow-up (p < 0.05). Average post-operative (1 month) Tegner-Lysholm score: 75 (range: 62–79). Median post-operative Tegner activity: 8. Mean side-to-side (KT-1000): 1.2 mm. A total of 22 patients could go back to pre-injury sport activity, with an average rehabilitation of 7.3 months.

Discussion

A significant number of cases were included in our structured standardized study and follow-up. Functional scores were excellent overall. Excellent results are testified by a final achievement of 22 patients going back to pre-injury sport activity, which is in keeping with the literature. Our experience exhibited a low complication rate and no metalwork failure. We correlate our results to the use of the Over the Top technique with lateral extra-articular tenodesis.

Conclusion

The studied procedure seems to be an excellent option and an effective, feasible and safe technique when treating ruptured ACLs in skeletally immature patients.

Dodwell ER, Lamont LE, Green DW, Pan TJ, Marx RG (2014) Lyman S. 20 years of pediatric anterior cruciate ligament reconstruction in New York state. Am J Sports Med 42(3):675–680CrossRefPubMed

Aichroth PM, Patel DV, Zorrilla P (2002) The natural history and treatment of rupture of the anterior cruciate ligament in children and adolescents. A prospective review. J Bone Joint Surg (Br) 84(1):38–41CrossRef

Anderson AF (2003) Transepiphyseal replacement of the anterior cruciate ligament in skeletally immature patients: a preliminary report. J Bone Joint Surg Am 85(7):1255–1263CrossRefPubMed

Placella G, Bartoli M, Peruzzi M, Speziali A, Pace V, Cerulli G (2016) Return to sport activity after anterior cruciate ligament reconstruction in skeletally immature athletes with manual drilling original all inside reconstruction at 8 years follow-up. Acta Orthop Traumatol Turc 50(6):635–638CrossRefPubMedPubMedCentral

Calvo R, Figueroa D, Gili F, Vaisman A, Mococxain P, Espinosa M, Leon A, Arellano S (2015) Transphyseal anterior cruciate ligament reconstruction in patients with open physes10-year follow-up study. Am J Sports Med 45(4):856–863 43(2):289–94

Graf BK, Lange RH, Fujisaki CK, Landry GL, Saluja RK (1992) Anterior cruciate ligament tears in skeletally immature patients: meniscal pathology at presentation and after attempted conservative treatment. Arthroscopy. 8(2):229–233CrossRefPubMed

Hawkins RJ, Misamore GW, Merritt TR (1986) Follow up of the acute non-operated isolated anterior cruciate ligament tear. Am J Sports Med 14(3):205–210CrossRefPubMed

Kannus P, Jarvinen M (1988) Knee ligament injuries in adolescents. Eight year follow-up of conservative management. J Bone Joint Surg (Br) 70(5):772–776CrossRef

Mizuta H, Kubota K, Shiraishi M, Otsuka Y, Nagamoto N, Takagi K (1995) The conservative treatment of complete tears of the anterior cruciate ligament in skeletally immature patients. J Bone Joint Surg (Br) 77(6):890–894CrossRef

10.

Cordasco FA, Watson Mayer S, Green DW (2017) MS all-inside, all-epiphyseal anterior cruciate ligament reconstruction in skeletally immature athletes return to sport, incidence of second surgery, and 2-year clinical outcomes. Am J Sports Med 45(4):856–863CrossRefPubMed

11.

Kocher MS, Garg S, Micheli LJ (2006) Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescents: surgical technique. J Bone Joint Surg Am 88(Suppl 1(Pt 2)):283–293CrossRefPubMed

12.

McCarthy MM, Graziano J, Green DW, Cordasco FA (2012) All-epiphyseal, all-inside anterior cruciate ligament reconstruction technique for skeletally immature patients. Arthrosc Tech 1(2):e231–e239CrossRefPubMedPubMedCentral

13.

Longo UG, Ciuffreda M, Casciaro C, Mannering N, Candela V, Salvatore G, Denaro V (2017) Anterior cruciate ligament reconstruction in skeletally immature patients : a systematic review. Bone Joint J 99-B(8):1053–1060CrossRefPubMed

14.

Marcacci M, Zaffagnini S, Iacono F et al (1998) Knee Surg Sports Traumatol Arthrosc (1998) Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons. Knee Surg Sports Traumatol Arthrosc 6(2):68–75 6(2):68–75CrossRefPubMed

15.

Roberti di Sarsina, Macchiarola L, Signorelli C, Grassi A, Raggi F, Marcheggiani Muccioli GM, Zaffagnini S..(2018) Anterior cruciate ligament reconstruction with an all-epiphyseal “over-the-top” technique is safe and shows low rate of failure in skeletally immature athletes. Sports Traumatology, Arthroscopy https://doi.org/10.1007/s00167-018-5132-y

16.

Paley D (2005) Radiographic assessment of lower limb deformities. In: Paley D, Herzenberg JE (eds) Principles of deformity correction. springer, New York, pp 31–38

17.

Bales CP, Guettler JH, Moorman CT III (2004) Anterior cruciate ligament injuries in children with open physes: evolving strategies of treatment. Am J Sports Med 32(8):1978–1985CrossRefPubMed

18.

Ramski DE, Kanj WW, Franklin CC, Baldwin KD, Ganley TJ (2014) Anterior cruciate ligament tears in children and adolescents: a meta-analysis of non-operative versus operative treatment. Am J Sports Med 42(11):2769–2776CrossRefPubMed

19.

Nawabi DH, Jones KJ, Lurie B, Potter HG, Green DW, Cordasco FA (2014) 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 42(12):2933–2940CrossRefPubMed

20.

Paletta GA Jr (2011) Complete transphyseal reconstruction of the anterior cruciate ligament in the skeletally immature. Clin Sports Med 30(4):779–788CrossRefPubMed

21.

Senorski E H, Seil R, Svantesson E, Feller J A, Webster K E, Engebretsen L, · Spindler K, · Siebold R, Karlsson J, Samuelsson K. (2018) Return to sport and becoming an elite athlete after paediatric and adolescent anterior cruciate ligament injury—current evidence and future directions. Knee Surg Sports Traumatol Arthrosc 26(4):1011–1018

22.

Webster KE, Feller JA, Whitehead TS, Myer GD, Merory PB (2017) Return to sport in the younger patient with anterior cruciate ligament reconstruction. Orthop J sports med Orthop J sports med 5(4):2325967117703399. https://doi.org/10.1177/2325967117703399.eCollection2017Apr

23.

Grassi A, Zicaro JP, Costa-Paz M, Samuelsson K, Wilson A, Zaffagnini S, Condello V, ESSKA Arthroscopy Committee (2019) Good mid-term outcomes and low rates of residual rotatory laxity, complications and failures after revision anterior cruciate ligament reconstruction (ACL) and lateral extra-articular tenodesis (LET). Knee Surg Sports Traumatol Arthrosc 2019. https://doi.org/10.1007/s00167-019-05625-w

24.

Ariel de Lima D, Helito CP, Lima FRA, Leite JAD (2018) Surgical indications for anterior cruciate ligament reconstruction combined with extra-articular lateral tenodesis or anterolateral ligament reconstruction. Rev Bras Ortop 53(6):661–667. https://doi.org/10.1016/j.rboe.2018.09.007 CrossRefPubMedPubMedCentral

25.

Mathew M, Dhollander A, Getgood A (2018) Anterolateral ligament reconstruction or extra-articular tenodesis: Why and when? Clin Sports Med 37(1):75–86. https://doi.org/10.1016/j.csm.2017.07.011 CrossRefPubMed

26.

Cerciello S, Batailler C, Darwich N, Neyret P (2017) Extra-articular tenodesis in combination with anterior cruciate ligament reconstruction: an overview. Clin Sports Med 37(1):87–100. https://doi.org/10.1016/j.csm.2017.07.006 CrossRefPubMed

27.

Daniel Green MD, Frank Cordasco MD, Meghan Price BS (2019) return to sport and reoperation rates in patients under the age of 20 following primary anterior cruciate ligament reconstruction: risk profile comparing three patient groups predicated upon skeletal age. Am J Sports Med 47(3):628–639. https://doi.org/10.1177/0363546518819217Epub 2019 Jan 15 CrossRefPubMed

28.

Grindem H, Eitzen I, Engebretsen L, Snyder-Mackler L, Risberg MA (2014) nonsurgical or surgical treatment of ACL injuries: knee function, sports participation, and knee reinjury: the Delaware-Oslo ACL cohort study. J Bone Joint Surg Am 96(15):1233–1241CrossRefPubMedPubMedCentral

29.

Zaffagnini S, Marcheggiani Muccioli GM, Grassi A, Roberti di Sarsina T, Raggi F, Signorelli C, Urrizola F, Spinnato P, Rimondi E, Marcacci M (2017) Over-the-top ACL reconstruction plus extra-articular lateral tenodesis with hamstring tendon grafts: prospective evaluation with 20-year minimum follow-up. Am J Sports Med 45(14):3233–3242. https://doi.org/10.1177/0363546517723013 CrossRefPubMed

30.

Sonnery-Cottet B, Barbosa NC, Vieira TD, Saithna A (2018) Clinical outcomes of extra-articular tenodesis/anterolateral reconstruction in the ACL injured knee. Knee Surg Sports Traumatol Arthrosc 26(2):596–604. https://doi.org/10.1007/s00167-017-4596-5 Epub 2017 Jun 12CrossRefPubMed

31.

De Phillipo NN, Cinque ME, Chahla J, Geeslin AG, La Prade RF (2017) Anterolateral ligament reconstruction techniques, biomechanics, and clinical outcomes: a systematic review. Arthroscopy 33(8):1575–1583. https://doi.org/10.1016/j.arthro.2017.03.009 CrossRef

32.

Macintosh DL, Darby TA (1976) Lateral substitution reconstruction. J Bone Joint Surg (Br) 58:142

Title: Over the top anterior cruciate ligament reconstruction in patients with open physes: a long-term follow-up study
Authors: Riccardo Maria Lanzetti
Valerio Pace
Alessandro Ciompi
Dario Perugia
Marco Spoliti
Francesco Falez
Caraffa Auro
Publication date: 01-04-2020
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 4/2020
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04490-4

At a glance: The STEP trials

Springer Medicine

Over the top anterior cruciate ligament reconstruction in patients with open physes: a long-term follow-up study

Abstract

Introduction

Methods

Results

Discussion

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Discussion

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2020

The history of bone marrow in orthopaedic surgery (part I trauma): trepanning, bone marrow injection in damage control resuscitation, and bone marrow aspiration to heal fractures

Gross trunnion failure in metal on polyethylene total hip arthroplasty—a systematic review of literature

Management of subtrochanteric fractures by nail osteosynthesis: a review of tips and tricks

Anatomy of clavicle in the Indian population and its applicability in pre-contoured plating

Functional outcome of open distal femoral fractures managed with lateral locking plates

Experience of valgus osteotomy for neglected and failed osteosynthesis in fractures neck of femur