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Over the top anterior cruciate ligament reconstruction in patients with open physes: a long-term follow-up study

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Abstract

Introduction

Anterior cruciate ligament (ACL) rupture in skeletally immature athletes is becoming an injury with increasing incidence. Choices of treatment are still debated, including conservative management vs. various surgical techniques. The lack of long-term reports has been highlighted in the literature. Aim: To evaluate long-term results of ACL reconstructions performed in skeletally immature patients using the Over the Top technique with lateral extra-articular tenodesis.

Methods

Retrospective study. All surgeries performed by same surgeon. A total of 42 patients included. All patients had pre-operative radiological studies. Subjects: 30 males and 12 females. Average age: 12.5 years (range 11–14 years). Average follow-up: 96.1 months. Clinical evaluation: Pedi-IKDC, Tegner-Lysholm, KT-1000 and plain radiographs. Standardized rehabilitation protocol.

Results

No instability or leg length discrepancy was recorded. Average pre-operative Tegner-Lysholm and Pedi-IKDC scores were 55 and 40, respectively, with a score of 94.8 (p < 0.05) and 94.78, respectively, at final follow-up (p < 0.05). Average post-operative (1 month) Tegner-Lysholm score: 75 (range: 62–79). Median post-operative Tegner activity: 8. Mean side-to-side (KT-1000): 1.2 mm. A total of 22 patients could go back to pre-injury sport activity, with an average rehabilitation of 7.3 months.

Discussion

A significant number of cases were included in our structured standardized study and follow-up. Functional scores were excellent overall. Excellent results are testified by a final achievement of 22 patients going back to pre-injury sport activity, which is in keeping with the literature. Our experience exhibited a low complication rate and no metalwork failure. We correlate our results to the use of the Over the Top technique with lateral extra-articular tenodesis.

Conclusion

The studied procedure seems to be an excellent option and an effective, feasible and safe technique when treating ruptured ACLs in skeletally immature patients.

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Acknowledgments

We would like to thank Prof. Caraffa for his support throughout the development of the study and all patients and their family for their availability and kindness.

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Authors and Affiliations

  1. Orthopaedics and Traumatology Unit, Department Emergency and Acceptance, San Camillo - Forlanini Hospital Rome,Italy, Cir.ne Gianicolense 87, 00152, Rome, Italy

    Riccardo Maria Lanzetti & Marco Spoliti

  2. Università degli studi di Perugia- Perugia- Italy, Piazzale Gambuli, 06100, Perugia, Italy

    Valerio Pace & Caraffa Auro

  3. Santo Spirito Hospital, Lungotevere in Sassia 1, 00193, Rome, Italy

    Alessandro Ciompi & Francesco Falez

  4. “La Sapienza” University, Via Elio Chianesi, 00128, Rome, Italy

    Dario Perugia

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  1. Riccardo Maria Lanzetti
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  2. Valerio Pace
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Correspondence to Riccardo Maria Lanzetti.

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The authors disclose any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work. The authors also wish to disclose any competing interest(s) that may be perceived to influence the results and discussion reported in this paper.

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Lanzetti, R.M., Pace, V., Ciompi, A. et al. Over the top anterior cruciate ligament reconstruction in patients with open physes: a long-term follow-up study. International Orthopaedics (SICOT) 44, 771–778 (2020). https://doi.org/10.1007/s00264-020-04490-4

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