The Anterior Cruciate Ligament is part of four primary ligaments of the knee joint. It aids in the rotational stability of the knee and prevents the shinbone (tibia) from slipping in front of the thighbone (femur). It is particularly prone to injury from impact or athletic activity. Reconstruction is currently the standard-of-care surgical treatment for ACL injuries. This procedure entails inserting a graft into the knee through a small incision. If the surgery is unsuccessful, a revision procedure is required. This may result in a higher failure rate and a lower rate of return to sport. In the United States, over 300,000 ACL repairs are performed each year. Reconstruction alone has not been sufficient for children who have not finished growing and wish to participate in sports.
A team has now discovered that a unique surgical approach used during anterior cruciate ligament (ACL) reconstruction yielded favourable results two years after surgery in select younger patients. The study looked at the efficacy and safety of conducting a lateral extra-articular tenodesis (LET). This was done together with the modified Lemaire technique (MLT) in conjunction with an ACL reconstruction in children and adolescents who are at a high risk of having their ACL repair fail. The findings are highly relevant for the ACL Reconstruction Market as the approach was related to favourable patient-reported outcomes. Further, it also showed a high return to the sports participation rate and a low ACL re-tear rate.
This is one of the first surgical-technique papers describing how this procedure can be safely performed in young patients with open growth plates. Researchers added that the study is also unique in that it reports on two-year clinical outcomes in children who underwent this specific procedure.
The research tracked 61 children aged 11 to 19 who received simultaneous ACL reconstruction and LET throughout a two-year period. Depending on the patient's skeletal, the ACL restoration was done utilising full-thickness quadriceps tendon or bone-patellar. In addition, the tendon-bone autograft, all-epiphyseal, or total transphyseal procedures maturity was also taken into consideration. It was realized that 97 per cent of the patients engaged in organised activities, with soccer being the most popular.
The findings were very encouraging, with a median Single Assessment Numeric Evaluation (SANE) score of 95%. Therein 100% signifies normal function. The average Pediatric International Knee Documentation Committee (Pedi-IKDC) score was 91, with a score of 100 indicating no restrictions on everyday living or sporting activities.
This approach does not disrupt children's growth plates or create post-operative stiffness. Moreover, it also has a remarkable low re-tear rate in this high-risk cohort.