Abstract
Introduction and Aims: The aims of this study were to compare the over-the-top and four-strand techniques of paediatric anterior cruciate ligament reconstruction. An age and sex-matched control study of these two different ACL reconstructive techniques was done to determine if there are differences in instability, functional outcomes and growth plate-related problems.
Method: Injuries, treatment and associated complications were collected from hospital charts. Pre-operative x-rays were used to determine growth plate status both at the distal femur and the proximal tibia. Pre-operative MRIs were studied to assess the position and nature of mid-substance ACL tear and any associated meniscal tear or pathology. Follow-up included examination as per International Knee Documentation Committee guidelines, including patient history and a clinical examination assessing the degree of anterior draw, presence and quality of a pivot shift test and pivot glide, and arthrometric measurements using the KT-1000 Arthrometer for anterior translational distance in millimetres. The Lysholm questionnaire was completed by all patients.
Results: Thirty-nine paediatric patients were reviewed for anterior cruciate ligament injuries requiring reconstruction at the authors’ institution. Data collected included background information on the injury, including mechanism and age at injury and surgical information including age at surgery, surgical procedure, and technique. Surgical follow-up information was also collected including wound problems, re-ruptures, or growth arrests. The mean age at injury was 14.3 years. The predominant mechanism of injury was twist and turn with 21 reports. The average age at surgery was 15.2 years, with 20 patients undergoing reconstruction of their ACL alone and 19 patients repair of their ACL and menisci. Fourteen patients were treated using the four-strand technique, while 25 patients were treated using the over-the-top method. We have an average follow-up of 1.9 years post-surgery. Three patients in the over-the-top group had wound infections. There were no known growth arrests or re-ruptures in this patient group based on this limited follow-up. Fifty-five percent of patients had meniscal involvement. Those with a meniscal tear were older than those without (14.5 years versus 11.5 years; p< 0.05).
Conclusion: Once rare, injuries of the anterior cruciate ligament in skeletally immature patients have become a common clinical presentation. It is important to have a documentation of the amount of pathologic laxity of the knee joint. Instrumented measurements can show the success of an ACL reconstruction in restoring the patient’s knee to normal joint kinetics.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
At least one of the authors is receiving or has received material benefits or support from a commercial source.
