TY - JOUR
T1 - Assessment of Skeletal Maturity and Postoperative Growth Disturbance After Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients
T2 - A Systematic Review
AU - PLUTO Study Group
AU - Fury, Matthew S.
AU - Paschos, Nikolaos K.
AU - Fabricant, Peter D.
AU - Anderson, Christian N.
AU - Busch, Michael T.
AU - Chambers, Henry G.
AU - Christino, Melissa A.
AU - Cordasco, Frank A.
AU - Edmonds, Eric W.
AU - Ganley, Theodore J.
AU - Green, Daniel W.
AU - Heyworth, Benton E.
AU - Lawrence, J. Todd R.
AU - Matava, Matthew J.
AU - Micheli, Lyle J.
AU - Milewski, Matthew D.
AU - Nepple, Jeffrey J.
AU - Parikh, Shital N.
AU - Pennock, Andrew T.
AU - Perkins, Crystal A.
AU - Saluan, Paul M.
AU - Shea, Kevin G.
AU - Wall, Eric J.
AU - Willimon, Samuel C.
AU - Kocher, Mininder S.
N1 - Publisher Copyright:
© 2021 The Author(s).
PY - 2022/4
Y1 - 2022/4
N2 - 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.
AB - 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.
KW - ACL
KW - ACL reconstruction
KW - angular deformity
KW - anterior cruciate ligament
KW - growth disturbance
KW - leg length discrepancy
KW - skeletally immature
UR - http://www.scopus.com/inward/record.url?scp=85125886067&partnerID=8YFLogxK
U2 - 10.1177/03635465211008656
DO - 10.1177/03635465211008656
M3 - Article
C2 - 33984243
AN - SCOPUS:85125886067
SN - 0363-5465
VL - 50
SP - 1430
EP - 1441
JO - American Journal of Sports Medicine
JF - American Journal of Sports Medicine
IS - 5
ER -