Arthroscopic reconstruction of the ACL with semitendinosus-gracilis autograft in skeletally immature adolescent patients.

It has been recommended that reconstruction of the anterior cruciate ligament (ACL) in skeletally immature patients should not violate the physeal plate of the distal femur or proximal tibia as growth irregularity might occur. Despite the lack of conclusive evidence that tendon transfers through growth areas cause growth irregularity, recent reports suggest that ligament reconstruction be performed in a nonisometric fashion to avoid violating the growth plate. Eight skeletally immature individuals underwent ligament reconstruction (average age: 14 years 9 months) and were reviewed retrospectively at an average of 32 months postsurgery. Surgery was performed using a hamstring tendon autograft through femoral and tibial tunnels (7 to 9 mm). Seven patients underwent scanograms at follow-up to confirm skeletal limb equality. All patients had at least 2 cm longitudinal growth after surgery. Stability tests were performed using both manual and KT-1000 arthrometer measurements. No clinically significant limb-length discrepancy or angular deformity was observed. Stability was excellent in five patients (< 3 mm side-to-side difference) and 8 mm in a patient with a repeat injury. Two patients presented with contralateral ACL-deficient knees. All eight patients were able to return to the same sport as before the injury. Modified Cincinnati Knee Rating scores revealed 100% excellent results in those four patients acutely reconstructed with average postoperative scores of 98 points. The four patients with chronic tears also exhibited average postoperative scores of 98 points. Ligament reconstruction using the semitendinosus and gracilis autograft can give excellent results in the skeletally immature individual. There appears to be minimal risk to the growth areas of the tibia or the femur at the knee. The graft can be safely passed through anatomically accurate bony drill holes in an arthroscopic fashion without apparent damage.