THE OUTCOME OF OPERATIVELY TREATED ANTERIOR CRUCIATE LIGAMENT DISRUPTIONS IN THE SKELETALLY IMMATURE CHILD

The purpose of this study was to evaluate the outcome of transphyseal ligament reconstruction in skeletally immature children with midsubsta nce anterior cruciate ligament (ACL) disruption. Five consecutive pati ents (mean age, 12.9 years; range, 8 to 14 years) with radiographicall y documented ''wide'' open growth plates and a minimum of 5 cm of expe cted remaining growth, underwent intraarticular reconstruction of the ACL. Operative treatment included three ACL reconstructions using hams tring tendons and two with quadriceps patellar tendon. All involved a centrally placed 6-mm or smaller tibial drill hole through an open phy sis and graft placement in an over-the-top position on the femur. At a n average follow-up of 7.4 years (range, 4.5 to 9.9 years), no patient had a positive anterior drawer, Lachman, or pivot shift test. On KT-1 000 arthrometer testing, all patients had 3 mm or less of increased an terior-posterior displacement (mean +/- SD = 1.0 +/- 1.6 mm). Magnetic resonance imaging showed that four tibial physes had fused in a symme tric fashion and one was still open. Orthoroentgenograms showed that n o patient had a significant leg length discrepancy (-0.8 mm +/- 3.4 mm ). The mean increase in height postoperatively was 17.7 cm (range, 7.6 to 31.0 cm). Overall, using the International Knee Documentation Comm ittee (IKDC) evaluation form, there were four patients with grade A an d one with grade C, The one patient with a poor IKDC grade had sustain ed a subsequent patellar dislocation with osteochondral fracture. In c onclusion, ACL reconstruction using small drill holes placed through o pen tibial physes does not seem to adversely affect outcome or future growth.