Over-the-Top Anterior Cruciate Ligament Reconstruction With Lateral Extra-articular Tenodesis in Pediatric Athletes Provides Excellent Functional Outcomes and Preserves Growth Plate Symmetry.

PURPOSE: To assess clinical and radiological outcomes of pediatric anterior cruciate ligament (ACL) reconstruction using the over-the-top technique (OTT) combined with the lateral extra-articular tenodesis (LET) technique in skeletally immature patients, providing insights into its safety, efficacy, and effects on the growing knee.

METHODS

A retrospective study was conducted on skeletally immature soccer players undergoing ACL reconstruction with OTT + LET between 2019 and 2023 with a minimum follow-up of 2 years. Functional assessment included Lysholm, Knee Injury and Osteoarthritis Outcome Score, as well as KT-1000 testing. Radiological parameters included mechanical axis deviation, mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, anterior superior iliac spine-medial malleolus distance, femoral/tibial lengths, and limb alignment. Paired t-tests/Wilcoxon tests were used, with P < .05 considered significant.

RESULTS

Nineteen skeletally immature soccer players (mean age 12.8 ± 0.9 years) underwent ACL reconstruction with OTT + LET. At a mean follow-up of 43.6 ± 15.9 months [28-75], patients showed excellent functional outcomes (Lysholm 96.7 ± 10.9; Knee Injury and Osteoarthritis Outcome Score 94.6 ± 9.4). Clinical stability was restored in 94.4% of cases, with only 1 rerupture (5.6%). Radiological comparisons showed symmetrical alignment and bone lengths. A statistically significant reduction in mechanical medial proximal tibial angle was observed in operated knees compared with contralateral knees (85.0° vs 86.5°, P = .003).

CONCLUSIONS

ACL reconstruction using the OTT physeal-sparing technique combined with LET provided excellent clinical outcomes in our small sample of skeletally immature athletes. At a minimum of 2 years of follow-up, functional results were favorable, stability was restored, and radiological findings showed overall limb symmetry. The only significant radiological difference was a reduction of 1.5° in the mechanical medial proximal tibial angle.

LEVEL OF EVIDENCE: Level IV, retrospective therapeutic case series.