OTSR - 2026-03-20 - Journal Article
Combined ACL and ALL anatomic reconstruction in skeletally immature patients: clinical outcomes and growth safety.
Behr J, Bertout C, Noailles T, Geffroy L
Topics
Key Takeaway
Combined ACL-ALL anatomic reconstruction in skeletally immature patients yielded a 2.6% graft failure rate and 2.6% growth disturbance rate at mean 3.6-year follow-up, with mean Pedi-IKDC and Lysholm scores of 98.2 and 98.6, respectively.
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Summary
This retrospective monocentric study evaluated graft failure rate, growth safety, and return-to-sport outcomes in skeletally immature patients (bone age <14 years boys, <12 years girls) undergoing combined ACL-ALL reconstruction with hamstring graft using a transphyseal tibial tunnel and unique epiphyseal femoral tunnel. At mean 3.6-year follow-up, only 1 graft failure (2.6%) and 1 growth disturbance (2.6%) occurred, neither requiring additional surgery. All 39 patients returned to sport, with mean Pedi-IKDC 98.2 and Lysholm 98.6.
Key Limitation
The absence of a concurrent control group receiving isolated ACL reconstruction prevents any causal attribution of the low failure rate to the ALL component versus patient selection, surgical technique, or rehabilitation factors.
Original Abstract
INTRODUCTION
Surgical management of anterior cruciate ligament (ACL) injuries in skeletally immature patients remains challenging due to the presence of open growth plates and the higher risk of graft failure compared to adults. The addition of an anterolateral ligament (ALL) reconstruction could improve stability and reduce failure risk, but concerns about growth disturbances persist.
OBJECTIVE
To determine the graft failure rate, growth safety, and return-to-sport outcomes after combined ACL-ALL anatomic reconstruction using a hamstring graft in skeletally immature patients. We hypothesized that this combined technique would be associated with a low graft failure rate while preserving growth safety and satisfactory functional outcomes.
METHODS
We conducted a retrospective monocentric study including 39 patients (bone age <14 years for boys, <12 years for girls) who underwent combined ACL-ALL reconstruction using hamstring graft. The tibial tunnel was transphyseal, and the femoral tunnel was unique epiphyseal and performed under fluoroscopic control. The Pedi-IKDC, Lysholm, and Tegner scores were recorded before surgery and at final follow up. Graft rupture, surgical complication and growth disturbance were also assessed at final follow up.
RESULTS
After a mean follow-up of 3,6 years (1,9-5,3), only one graft failure (2.6%) and one growth disturbances (2.6%) were observed without clinical consequence or need for additional surgical treatment. No postoperative complications occurred. The mean Pedi-IKDC and Lysholm scores were 98.2 (range, 70-100) and 98.6 (range, 70-100), respectively. All patients returned to sport and only eight resumed at a lower level, with no cases of instability or significant growth discrepancy.
CONCLUSION
Combined ACL-ALL reconstruction using hamstring graft and a unique epiphyseal femoral tunnel provides excellent functional outcomes with low rates of rerupture and growth disturbance in skeletally immature patients.
LEVEL OF EVIDENCE
IV; retrospective case series.