Clinical Results of ACL Reconstruction in the Immature Adolescent via Transphyseal Approach in Tibia Based on a New Indication Paradigm

새로운 수술적응증에 의한 골 미성숙 전방십자인대 손상 환자에서의 성장판을 통과하는 전방십자인대 재건술의 결과

  • Lee, Dong Chul (Department of Orthopedic Surgery, Yeung-Nam University Hospital) ;
  • Shon, Oog Jin (Department of Orthopedic Surgery, Yeung-Nam University Hospital) ;
  • Park, Chul-Hyun (Department of Orthopedic Surgery, Yeung-Nam University Hospital) ;
  • Kwon, Moon Soo (Department of Orthopedic Surgery, Yeung-Nam University Hospital)
  • 이동철 (영남대학교 의과대학 정형외과학교실) ;
  • 손욱진 (영남대학교 의과대학 정형외과학교실) ;
  • 박철현 (영남대학교 의과대학 정형외과학교실) ;
  • 권문수 (영남대학교 의과대학 정형외과학교실)
  • Received : 2011.08.04
  • Accepted : 2012.01.27
  • Published : 2012.02.28

Abstract

Purpose: To evaluate clinical and radiologic outcomes of transphyseal anterior cruciate ligament (ACL) reconstruction in patients with open physes who were selected with authors' new operative indications. Materials and Methods: We evaluated 15 patients with open physes who underwent a transtibial ACL reconstruction and were followed up for 4~6 years after surgery. Our operative indications involved 1) choronologic age of ${\geq}$ 16 in male and ${\geq}$ 14 in female, 2) open physes of ${\leq}$ 2 mm width, and 3) Risser sign and Tanner stage of ${\geq}$ 3. Tibialis anterior tendon allograft was used in all patients, and endobutton and bioscrew were used for femoral and tibial fixations, respectively. Functional outcomes were evaluated using Lysholm Knee Scoring scale, Tegner activity scale, and International Knee Documentation Committee (IKDC) 2000 subjective score. Physical examinations to evaluate stability involved Lachman and pivot shift tests. For radiographic results, we evaluated side to side differences of anterior displacement in stress views. In addition, with use of scannograms taken at last follow-up, we examined side to side differences of femorotibial angles, anatomical and mechanical lateral distal femoral angles, mechanical medial proximal tibial angles and leg lengths. Results: The mean Lysholm Knee score was 51(40-61) points preoperatively and 97(94-100) points at last follow up. The mean Tegner activity score was 2.6 points preoperatively and 7.1 points at last follow up. The mean IKDC score was 32.6 points preoperatively and 88.3 points at last follow up. The mean anterior displacement of the tibia was improved from 6.7(${\pm}1.0$) mm to 1.9(${\pm}0.9$) mm. There were no leg length discrepancies over 5 mm and no statistically significant differences in all the radiographic variables representing growth disturbance. Conclusion: This study suggests that patients with open physes who selected by authors' new indication would safely undergo transphyseal ACL reconstruction with successful outcomes.