Growth Disturbance in Physeal Sparing ACL Reconstruction: A Comparison of 3 ACLR Techniques in Skeletally Immature Patients

Authors

• Adrianna Kowblansky, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
• Jeremy Le, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
• Sarah Dance, Department of Orthopaedic Surgery and Sports Medicine, Children's National Hospital, Washington, District of Columbia, USA.
• Madeline Rocks, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
• Jared Nowell, Department of Orthopaedic Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia, USA.
• Sean Tabaie, Department of Orthopaedic Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA.
• Emily L. Niu, Department of Orthopaedic Surgery and Sports Medicine, Children's National Hospital, Washington, District of Columbia, USA.

Document Type

Journal Article

Publication Date

4-1-2026

Journal

Orthopaedic journal of sports medicine

Volume

14

Issue

4

DOI

10.1177/23259671261431851

Keywords

anterior cruciate ligament reconstruction; growth disturbance; knee ligaments; pediatric sports medicine

Abstract

BACKGROUND: In pediatric anterior cruciate ligament reconstruction (ACLR), there exists a potential to injure the open physis in skeletally immature patients and cause growth disturbance. Thus, there is a need to determine the optimal ACLR technique for this population. PURPOSE: To evaluate the functional outcomes and rates of physeal disturbance, graft failure, and reoperation after transphyseal and physeal-protecting techniques-including extraphyseal intra-articular and partial epiphyseal ACLR-within the skeletally immature population. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients who underwent primary ACLR from June 2018 to April 2023 at a tertiary pediatric hospital were identified. The exclusion criteria included skeletal maturity based on preoperative magnetic resonance imaging, concomitant multi-ligamentous injury, excluding medial collateral ligament sprain that did not require surgical intervention, and <6 months of follow-up. Descriptive, injury, and surgical data; clinical outcomes; and complications were analyzed using the chi-square and Kruskal-Wallis tests. Growth disturbance was assessed using pre- and postoperative standing hip-to-ankle films. RESULTS: A total of 87 patients met the study inclusion criteria. A total of 41 (47.1%) patients underwent transphyseal (mean age, 15.2 ± 0.9), 34 (39.1%) underwent extraphyseal intra-articular (12.9 ± 1.7), and 12 (13.8%) underwent partial epiphyseal (14.6 ± 1.2) ACLR. The transphyseal group was significantly older in chronological and skeletal age (P < .001). Autograft types varied significantly across cohorts (P < .001). The partial epiphyseal technique had the highest rate of complications (50%; P = .009), most commonly stiffness (n = 2) and ACL retear (n = 2). Four (4.6%) patients experienced unilateral growth disturbance, with 1 in the extraphyseal intra-articular group. Angular growth disturbance ranged from 3° to 5º of valgus. There were no cases of leg length discrepancy or growth arrest. CONCLUSION: Comparable angular growth disturbance and retear rates were observed across all 3 ACLR techniques in skeletally immature patients, suggesting acceptable outcomes with appropriate surgical technique.

APA Citation

Kowblansky, Adrianna; Le, Jeremy; Dance, Sarah; Rocks, Madeline; Nowell, Jared; Tabaie, Sean; and Niu, Emily L., "Growth Disturbance in Physeal Sparing ACL Reconstruction: A Comparison of 3 ACLR Techniques in Skeletally Immature Patients" (2026). GW Authored Works. Paper 9084.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/9084

Department

Orthopaedic Surgery