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Transphyseal Anterior Cruciate Ligament Reconstruction in the Skeletally ImmatureFollow-up to a Minimum of Sixteen Years of Age
Sujit Kumar, MBBS, MS, MRCS1; David Ahearne, FRCS(Tr&Orth)1; David M. Hunt, FRCS(Tr&Orth)1
1 Department of Orthopaedics, St. Mary’s Hospital, Praed Street, London W2 1NY, United Kingdom. E-mail address for D.M. Hunt: davidhunt@uk-consultants.co.uk
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Investigation performed at the Department of Orthopaedics, St. Mary’s Hospital, London, and The Wellington Hospital, London, United Kingdom

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Jan 02;95(1):e1 1-6. doi: 10.2106/JBJS.K.01707
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The evidence in favor of early surgical treatment of anterior cruciate ligament (ACL) injuries in children is increasing. However, the controversy regarding the safety of such a procedure in young athletes with wide open physes remains unresolved.


We reviewed prospectively collected outcome data on consecutive patients who had undergone transphyseal ACL reconstruction at either (1) an age of less than fourteen years and Tanner stage 1 or 2, or (2) an age of less than twelve years and Tanner stage 3. Children who had less than four years of follow-up, who were younger than sixteen years at the time of final follow-up, or who had been at Tanner stage 4 at the time of surgery were excluded. Twenty-eight of the thirty-two included patients had been at Tanner stage 1 or 2 at the time of surgery, and the remaining four had been at Tanner stage 3 but had been younger than twelve years of age. The mean age at the time of the surgery was 11.25 years (range, 9.5 to 14.0 years; median, 12.1 years). The mean duration of follow-up was 72.3 months (range, forty-eight to 129 months; median, seventy-two months).


The mean Lysholm score improved from 71.5 preoperatively to 95.86 postoperatively (p < 0.0001). The mean Tegner activity scale score improved from 4.03 to 7.66 (p < 0.0001), which was comparable with the preinjury score of 8.0. One patient had a mild valgus deformity with no functional disturbance, and none had a limb-length discrepancy. One rerupture occurred, but all other patients had a good or excellent outcome.


This case series indicates good long-term results of ACL reconstruction with use of a transphyseal technique in young children.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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