{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T18:34:26Z","timestamp":1788978866719,"version":"build-2803163510"},"reference-count":39,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To evaluate the functional outcomes and rates of physeal disturbance, graft failure, and reoperation after transphyseal and physeal-protecting techniques\u2014including extraphyseal intra-articular and partial epiphyseal ACLR\u2014within the skeletally immature population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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 &lt;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 87 patients met the study inclusion criteria. A total of 41 (47.1%) patients underwent transphyseal (mean age, 15.2 \u00b1 0.9), 34 (39.1%) underwent extraphyseal intra-articular (12.9 \u00b1 1.7), and 12 (13.8%) underwent partial epiphyseal (14.6 \u00b1 1.2) ACLR. The transphyseal group was significantly older in chronological and skeletal age (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Autograft types varied significantly across cohorts (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). The partial epiphyseal technique had the highest rate of complications (50%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .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\u00b0 to 5\u00ba of valgus. There were no cases of leg length discrepancy or growth arrest.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671261431851","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T11:48:58Z","timestamp":1775735338000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Growth Disturbance in Physeal Sparing ACL Reconstruction: A Comparison of 3 ACLR Techniques in Skeletally Immature Patients"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7578-010X","authenticated-orcid":false,"given":"Adrianna","family":"Kowblansky","sequence":"first","affiliation":[{"name":"George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Le","sequence":"additional","affiliation":[{"name":"George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Dance","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sports Medicine, Children\u2019s National Hospital, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5766-2959","authenticated-orcid":false,"given":"Madeline","family":"Rocks","sequence":"additional","affiliation":[{"name":"George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1638-6353","authenticated-orcid":false,"given":"Jared","family":"Nowell","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Tabaie","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Nationwide Children\u2019s Hospital, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4170-7478","authenticated-orcid":false,"given":"Emily L.","family":"Niu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sports Medicine, Children\u2019s National Hospital, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.70B4.3403611"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200307000-00011"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659402200109"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465000280020601"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-1877"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.3928\/0147-7447-19980601-08"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/0749-8063(91)90003-g"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546519836423"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-010-1069-5"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2016.02.025"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000000606"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000001367"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513518412"},{"issue":"4","key":"e_1_3_2_15_2","first-page":"232","article-title":"Anterior cruciate ligament reconstruction in the immature athlete: long-term results of intra-articular reconstruction","volume":"14","author":"Edwards PH","year":"2001","unstructured":"Edwards PH, Grana WA. Anterior cruciate ligament reconstruction in the immature athlete: long-term results of intra-articular reconstruction. Am J Knee Surg. 2001;14(4):232-237.","journal-title":"Am J Knee Surg"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465211008656"},{"key":"e_1_3_2_17_2","volume-title":"Hand Bone Age, a Digital Atlas of Skeletal Maturity","author":"Gilsanz V","year":"2005","unstructured":"Gilsanz V, Ratib O. Hand Bone Age, a Digital Atlas of Skeletal Maturity. Springer-Verlag; 2005."},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465030310063401"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465030310063301"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2016.09.001"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2010.04.065"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e3181982228"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0749-8063(99)70016-2"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000001569"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.00441"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-200207000-00008"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.01560"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465231185742"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2006.07.014"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-199505000-00003"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.40455"},{"key":"e_1_3_2_32_2","unstructured":"R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing; 2020. Accessed May 5 2025. https:\/\/www.R-project.org"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-009-0988-5"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1177\/23259671231180874"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546503262169"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2010.11.062"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-023-06749-4"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000000482"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967118755330"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e3182210952"}],"container-title":["Orthopaedic Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259671261431851","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23259671261431851","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259671261431851","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:36:07Z","timestamp":1777595767000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23259671261431851"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":39,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1177\/23259671261431851"],"URL":"https:\/\/doi.org\/10.1177\/23259671261431851","relation":{},"ISSN":["2325-9671","2325-9671"],"issn-type":[{"value":"2325-9671","type":"print"},{"value":"2325-9671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"article-number":"23259671261431851"}}