ACL Reconstruction Improves Reinjury Rates in Skeletally Immature Athletes

Skeletally immature athletes who undergo an all-inside, physeal-sparing anterior cruciate ligament (ACL) reconstruction with a hamstring autograft can have good clinical outcomes without growth disturbance, according to recent study data.

“All-inside ACL reconstruction demonstrates excellent subjective and objective outcomes,” said Danyal H. Nawabi, M.D.

In the prospective study, Nawabi and his colleagues at the Hospital for Special Surgery evaluated 42 skeletally immature athletes who had a mean age of 12.7 years. The mean bone age was 13.5 years. Overall, 26 patients had an all-epiphyseal ACL reconstruction and 16 patients had a partial transphyseal ACL reconstruction, which spared the femoral physis but crossed the tibial physis. Nawabi and his colleagues used partial transphyseal ACL reconstruction for patients who had minimal proximal tibial growth remaining. Fourteen athletes were involved in recreational sports and 28 patients were competitive athletes. Lacrosse and soccer were the two most common sports played among the high-risk cohort.

The researchers found the mean time to return to unrestricted competitive play was 12.7 months after surgery. ACL re-rupture rate was 7 percent at a mean follow-up of 16.7 months. One athlete had a traumatic graft disruption 12 months postoperatively and had revision ACL reconstruction. In addition, one athlete had a contralateral ACL rupture at 11 months.

Nawabi said isokinetic testing showed minimum deficits and no angular deformities, leg length discrepancies or physeal disturbances were observed. Mean IKDC score was 92.9 ± 7.2, mean Lysholm score was 97.7 ± 4.6 and mean Marx activity rating scale score was 12.4 ± 3.5. All athletes had negative Lachman and pivot shift tests. Mean side-to-side difference in the KT-1000 arthrometer measurements was 0.9 ± 0.7 mm.

“We believe this low re-injury rate is due to avoiding an overreliance on objective data, such as a KT-1000 clinical examination, and focusing on the quality of movement which is essentially based on secondary injury prevention principles,” Nawabi said.