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Donaldson Foundation"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To understand if anatomic physeal\u2010sparing ACL reconstruction in the immature host preserves range of motion, permits a return to sports, and avoids limb length discrepancy and accelerated intra\u2010articular degeneration with a cross\u2010sectional radiographic, physical examination and patient\u2010reported outcomes analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross\u2010sectional recall study included 38 patients aged 7\u201315 who underwent all\u2010epiphyseal ACL reconstruction with hamstring allograft performed by a single surgeon at a large academic medical center. All\u2010epiphyseal reconstructions were performed using a modified Anderson physeal\u2010sparing technique, with the femoral tunnel placed using an \u201cinside\u2010out\u201d technique. Assessments consisted of a physical exam, long leg cassette radiographs, KT\u20101000\u00a0measurements, subjective patient metrics, and magnetic resonance imaging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010eight (56.7%) of 66 eligible patients returned for in\u2010person clinical and radiographic exams. Patients were 11.4\u2009\u00b1\u20091.8 years at the time of surgery. Five patients were females (13.2%). Mean follow\u2010up was 5.5\u2009\u00b1\u20092.4 years. ACL re\u2010injuries occurred in four patients (10.5%), all of whom underwent revision reconstructions. Thirty\u2010three of the remaining 34 (97.1%) patients returned to sports following their reconstruction, and 24 (70.6%) returned to their baseline level of competition. Mean limb length discrepancy (LLD) was 0.2\u2009\u00b1\u20091.4\u00a0cm. Nine patients had an LLD of\u2009&gt;\u20091\u00a0cm (26.5%), which occurred at an equivalent age as those with\u2009&lt;\u20091\u00a0cm LLD (10.8\u2009\u00b1\u20092.0 vs. 11.7\u2009\u00b1\u20091.7, n.s.). Pre\u2010operative Marx scores (13.1\u2009\u00b1\u20093.5) were not significantly different from post\u2010operative values (12.3\u2009\u00b1\u20095.1, n.s.). Patients who required ACL revisions had significantly lower Marx scores than those with intact primary grafts (8.3\u2009\u00b1\u20097.1 vs. 13.4\u2009\u00b1\u20094.5, <jats:italic>p<\/jats:italic>\u2009=\u20090.047). Cohort mean International Knee Documentation Committee (IKDC) score was 89.7\u2009\u00b1\u200912.7.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Anatomic all\u2010epiphyseal anatomic ACL reconstruction appears to be useful in patients with significant projected remaining growth, with good return\u2010to\u2010sport outcomes and minimal risk of clinically significant physeal complications. However, given the limited patient recall possible in the present study, further large sample size, high\u2010quality works are necessary to validate our findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-021-06542-7","type":"journal-article","created":{"date-parts":[[2021,4,3]],"date-time":"2021-04-03T07:02:42Z","timestamp":1617433362000},"page":"4251-4260","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Anatomic all\u2010epiphyseal ACL reconstruction with \u201cinside\u2010out\u201d femoral tunnel placement in immature patients yields high return to sport rates and functional outcome scores a minimum of 24\u00a0months after reconstruction"],"prefix":"10.1002","volume":"29","author":[{"given":"Mitchell Stephen","family":"Fourman","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department 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Donaldson Foundation (internal grant). Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent\/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All protocols performed in this work were approved by the University of Pittsburgh Institutional IRB (PRO14030158\u2014Clinical and Radiologic Outcomes of Anatomic Physeal Sparing ACL Reconstructive Techniques in the Pediatric Population) and were carried out in accordance with the ethical standards in the 1964 Declaration of Helsinki and relevant regulations of the US Health Insurance Portability and Accountability Act (HIPAA). Signed informed consent was obtained from all study participants.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}]}}