Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association · 2016
Growth Abnormalities Following Anterior Cruciate Ligament Reconstruction in the Skeletally Immature Patient: A Systematic Review.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Collins Michael J, Arns Thomas A, Leroux Timothy, Black Austin, Mascarenhas Randy, Bach Bernard R, Forsythe Brian
Аннотация
PURPOSE: To identify all reported cases of growth disturbances after anterior cruciate ligament (ACL) reconstruction in patients with open growth plates and analyze trends with respect to different surgical techniques, graft choices, and methods of fixation.
METHODS: A systematic literature review was conducted using the MEDLINE, EMBASE, and SCOPUS databases with the following term: "((anterior cruciate ligament OR ACL) AND ((((immature) OR growth plates) OR physes) OR pediatric))." Only studies that evaluated ACL reconstruction in patients with open growth plates and reported angular malformations or limb length discrepancy were included. Data were extracted, including patient characteristics, surgical technique, and postoperative growth disturbance.
RESULTS: Twenty-one studies containing 39 patients with growth abnormalities were included in the review. Mean chronological age was 13 years, and 89% of patients were male. Overall, there were 16 cases of angular malformations and 29 cases of limb length discrepancy. The most common angular malformation was genu valgum (81%, n = 13; mean of 6.5°). The most common surgical technique on the tibia and femur was transphyseal (54%, and 77% respectively), and the most common graft used was hamstring autograft (58%). Among patients with limb length discrepancy, overgrowth was most common (62%, n = 18; mean of 13 mm). Interestingly, we observed that 50% of patients with overgrowth underwent a physeal-sparing technique, whereas 64% of patients with shortening underwent a transphyseal technique.
CONCLUSIONS: At present, there are 21 studies reporting 39 patients with growth abnormalities in the current literature, of which 29 cases were of limb length discrepancy and 16 of angular malformation. Of the 29 cases of limb length discrepancy, limb overgrowth accounted for 62% of cases. Perhaps most interestingly, physeal-sparing techniques were performed in 25% of the cases of angular malformation and 47% cases of limb length discrepancy, despite the commonly held belief that this technique mitigates the risks of ACL reconstruction by not violating the growth plate. According to this study, it is clear that growth abnormalities after ACL reconstruction in the skeletally immature patient are underreported, and our current understanding of the etiology of these abnormalities is limited.
LEVEL OF EVIDENCE: Level IV, systematic review of Level II to IV studies.
METHODS: A systematic literature review was conducted using the MEDLINE, EMBASE, and SCOPUS databases with the following term: "((anterior cruciate ligament OR ACL) AND ((((immature) OR growth plates) OR physes) OR pediatric))." Only studies that evaluated ACL reconstruction in patients with open growth plates and reported angular malformations or limb length discrepancy were included. Data were extracted, including patient characteristics, surgical technique, and postoperative growth disturbance.
RESULTS: Twenty-one studies containing 39 patients with growth abnormalities were included in the review. Mean chronological age was 13 years, and 89% of patients were male. Overall, there were 16 cases of angular malformations and 29 cases of limb length discrepancy. The most common angular malformation was genu valgum (81%, n = 13; mean of 6.5°). The most common surgical technique on the tibia and femur was transphyseal (54%, and 77% respectively), and the most common graft used was hamstring autograft (58%). Among patients with limb length discrepancy, overgrowth was most common (62%, n = 18; mean of 13 mm). Interestingly, we observed that 50% of patients with overgrowth underwent a physeal-sparing technique, whereas 64% of patients with shortening underwent a transphyseal technique.
CONCLUSIONS: At present, there are 21 studies reporting 39 patients with growth abnormalities in the current literature, of which 29 cases were of limb length discrepancy and 16 of angular malformation. Of the 29 cases of limb length discrepancy, limb overgrowth accounted for 62% of cases. Perhaps most interestingly, physeal-sparing techniques were performed in 25% of the cases of angular malformation and 47% cases of limb length discrepancy, despite the commonly held belief that this technique mitigates the risks of ACL reconstruction by not violating the growth plate. According to this study, it is clear that growth abnormalities after ACL reconstruction in the skeletally immature patient are underreported, and our current understanding of the etiology of these abnormalities is limited.
LEVEL OF EVIDENCE: Level IV, systematic review of Level II to IV studies.