{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T20:08:12Z","timestamp":1785269292456,"version":"3.55.0"},"reference-count":35,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":56,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Paediatric anterior cruciate ligament (ACL) injuries are becoming increasingly frequent. Surgical management remains challenging due to the risk of growth plate disturbance. Physeal\u2010sparing techniques aim to restore stability while minimizing this risk. The purpose of this study is to evaluate the clinical, functional and radiological outcomes of an all\u2010inside, all\u2010epiphyseal ACL reconstruction in skeletally immature patients, with particular attention to complications, return to sport (RTS) and the influence of associated injuries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Seventy\u2010eight patients (48 males and 30 females; mean age 13.1 years, range: 9\u201316) underwent physeal\u2010sparing ACL reconstruction between 2015 and 2024. All procedures were performed using hamstring autograft with all\u2010epiphyseal sockets under fluoroscopic guidance. Pre\u2010 and postoperative assessments included plain radiographs, magnetic resonance imaging (MRI) and clinical evaluation. Outcome measures were Lysholm, Paediatric International Knee Documentation Committee (Pedi\u2010IKDC) and visual analogue scale (VAS) scores, recorded preoperatively and at a mean follow\u2010up of 48 months (range: 24\u201382). Return\u2010to\u2010play rates, complications and growth disturbances were documented. Subgroup analyses investigated the effect of meniscal\/chondral lesions, gender and surgical delay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Significant postoperative improvements were achieved in all clinical scores: Lysholm (53.4\u201394.6,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01), Pedi\u2010IKDC (53.5\u201390.6,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) and VAS (5.6\u20131.8,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). No growth arrest, angular deformities, or leg length discrepancies were identified. Complications included one infection, two re\u2010ruptures and one residual laxity. RTS was achieved in 94.8% of patients, with a mean recovery period of 11.1 months. Meniscal and chondral lesions were associated with inferior outcomes and delayed return\u2010to\u2010play. Delayed surgery significantly increased the risk of meniscal injury (odds ratio [OR]: 5.1,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>All\u2010inside physeal\u2010sparing ACL reconstruction demonstrates excellent mid\u2010 to long\u2010term outcomes in skeletally immature patients. The technique offers high RTS rates and minimal growth\u2010related complications. Early surgical intervention may reduce the risk of secondary meniscal and chondral damage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV, retrospective case series.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70671","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T21:28:24Z","timestamp":1773005304000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["All\u2010epiphyseal, all\u2010inside ACL reconstruction yields high return\u2010to\u2010sport and minimal growth\u2010related complications at mid\u2010 to long\u2010term follow\u2010up in skeletally immature patients"],"prefix":"10.1002","volume":"13","author":[{"given":"Panagiotis","family":"Ntagiopoulos","sequence":"first","affiliation":[{"name":"Hip and Knee Unit Mediterraneo Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8875-4007","authenticated-orcid":false,"given":"Georgios","family":"Kalinterakis","sequence":"additional","affiliation":[{"name":"Hip and Knee Unit Mediterraneo Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5450-7654","authenticated-orcid":false,"given":"Pierrenzo","family":"Pozzi","sequence":"additional","affiliation":[{"name":"U.O.C. 1\u00b0 Clinica Ortopedica ASST G. Pini\u2010CTO Milan Italy"},{"name":"Universit\u00e0 degli Studi di Milano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitris","family":"Fligkos","sequence":"additional","affiliation":[{"name":"Hip and Knee Unit Mediterraneo Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9002-3532","authenticated-orcid":false,"given":"George","family":"Themistocleous","sequence":"additional","affiliation":[{"name":"Hip and Knee Unit Mediterraneo Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sotirios","family":"Themistokleous","sequence":"additional","affiliation":[{"name":"Hip and Knee Unit Mediterraneo Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Triantafyllia","family":"Dimou","sequence":"additional","affiliation":[{"name":"Hip and Knee Unit Mediterraneo Hospital Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8259-8488","authenticated-orcid":false,"given":"Riccardo","family":"Compagnoni","sequence":"additional","affiliation":[{"name":"U.O.C. 1\u00b0 Clinica Ortopedica ASST G. 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