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Fury MS, Paschos NK, Fabricant PD. Assessment of Skeletal Maturity and Postoperative Growth Disturbance After Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review. Am J Sports Med. 2021;3635465211008656doi: 10.1177/03635465211008656.
Fury, M. S., Paschos, N. K., Fabricant, P. D., Anderson, C. N., Busch, M. T., Chambers, H. G., Christino, M. A., Cordasco, F. A., Edmonds, E. W., Ganley, T. J., Green, D. W., Heyworth, B. E., Lawrence, J. T. R., Matava, M. J., Micheli, L. J., Milewski, M. D., Nepple, J. J., Parikh, S. N., Pennock, A. T., Perkins, C. A., Saluan, P. M., Shea, K. G., Wall, E. J., Willimon, S. C., & Kocher, M. S. (2021). Assessment of Skeletal Maturity and Postoperative Growth Disturbance After Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review. The American journal of sports medicine, 3635465211008656. https://doi.org/10.1177/03635465211008656
Fury, Matthew S, et al. "Assessment of Skeletal Maturity and Postoperative Growth Disturbance After Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review." The American journal of sports medicine vol. (2021): 3635465211008656. doi: https://doi.org/10.1177/03635465211008656
Fury MS, Paschos NK, Fabricant PD, Anderson CN, Busch MT, Chambers HG, Christino MA, Cordasco FA, Edmonds EW, Ganley TJ, Green DW, Heyworth BE, Lawrence JTR, Matava MJ, Micheli LJ, Milewski MD, Nepple JJ, Parikh SN, Pennock AT, Perkins CA, Saluan PM, Shea KG, Wall EJ, Willimon SC, Kocher MS. Assessment of Skeletal Maturity and Postoperative Growth Disturbance After Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review. Am J Sports Med. 2021 May 13;3635465211008656. doi: 10.1177/03635465211008656. Epub 2021 May 13. PMID: 33984243.
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Am J Sports Med. 2021 May 13;3635465211008656. doi: 10.1177/03635465211008656. Epub 2021 May 13.

Assessment of Skeletal Maturity and Postoperative Growth Disturbance After Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review.

The American journal of sports medicine

Matthew S Fury, Nikolaos K Paschos, Peter D Fabricant, Christian N Anderson, Michael T Busch, Henry G Chambers, Melissa A Christino, Frank A Cordasco, Eric W Edmonds, Theodore J Ganley, Daniel W Green, Benton E Heyworth, J Todd R Lawrence, Matthew J Matava, Lyle J Micheli, Matthew D Milewski, Jeffrey J Nepple, Shital N Parikh, Andrew T Pennock, Crystal A Perkins, Paul M Saluan, Kevin G Shea, Eric J Wall, Samuel C Willimon, Mininder S Kocher

Affiliations

  1. Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, USA.
  2. Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA.
  3. Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
  4. Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
  5. Tennessee Orthopaedic Alliance, Nashville, Tennessee, USA.
  6. Children's Healthcare of Atlanta, Children's Orthopaedics of Atlanta, Atlanta, Georgia, USA.
  7. Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, San Diego, California, USA.
  8. Boston Children's Hospital, Division of Sports Medicine, Department of Orthopaedics, Harvard Medical School, Boston, Massachusetts, USA.
  9. Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA.
  10. Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
  11. Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
  12. Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
  13. Cleveland Clinic Orthopaedic and Rheumatologic Institute, Garfield Heights, Ohio, USA.
  14. Department of Orthopedic Surgery, Stanford University, Stanford, California, USA.

PMID: 33984243 DOI: 10.1177/03635465211008656

Abstract

BACKGROUND: Growth disturbance is an uncommon but potentially serious complication after anterior cruciate ligament (ACL) reconstruction in skeletally immature patients.

PURPOSE: To describe how the pediatric ACL literature has assessed preoperative skeletal maturity and the amount of growth remaining and to comprehensively review the incidence, reporting, and monitoring of postoperative growth disturbance.

STUDY DESIGN: Systematic review; Level of evidence, 4.

METHODS: This review included studies reporting original research of clinical outcomes of skeletally immature patients after ACL reconstruction. Patient characteristics, surgical techniques, preoperative assessments of skeletal maturity or growth remaining, and postoperative assessments of growth disturbances were extracted.

RESULTS: A total of 100 studies met inclusion criteria. All studies reported chronological age, and 28 studies (28%) assessed skeletal age. A total of 44 studies (44%) used Tanner staging, and 12 studies (12%) obtained standing hip-to-ankle radiographs preoperatively. In total, 42 patients (2.1%) demonstrated a leg length discrepancy (LLD) >10 mm postoperatively, including 9 patients (0.5%) with LLD >20 mm; furthermore, 11 patients (0.6%) with LLD underwent growth modulation. Shortening was the most common deformity overall, but overgrowth was reported more frequently in patients who had undergone all-epiphyseal techniques. Most LLDs involved the femur (83%). A total of 26 patients (1.3%) demonstrated a postoperative angular deformity ≥5°, and 9 of these patients underwent growth modulation. The most common deformities were femoral valgus (41%), tibial recurvatum (33%), and tibial varus (22%). Although standing hip-to-ankle radiographs were the most common radiographic assessment of growth disturbance, most studies inadequately reported the clinical and radiographic methods of assessment for growth disturbance. Additionally, only 35% of studies explicitly followed patients to skeletal maturity.

CONCLUSION: This systematic review described significant variability in the reporting and monitoring of growth-related complications after ACL reconstruction in skeletally immature patients. The incidence of LLD and angular deformity appeared to be low, but the quality of research was not comprehensive enough for accurate assessment.

REGISTRATION: CRD42019136059 (PROSPERO).

Keywords: ACL; ACL reconstruction; angular deformity; anterior cruciate ligament; growth disturbance; leg length discrepancy; skeletally immature

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