In a recent study, researchers reportedly compared two anterior cruciate ligament (ACL) reconstruction techniques in children, spotlighting one specific technique that they say demonstrated greater efficacy. Researchers from the New York City-based Hospital for Special Surgery (HSS) note that a technique called the All-Inside, All-Epiphyseal ACL Reconstruction (AE) offers great knee stability and effectively controls joint stress. 

The AE technique is available in only a few select centers nationwide, including HSS, says Frank Cordasco, MD, surgical director of the Ambulatory Surgery Center and member of the Sports Medicine and Shoulder Service at HSS. “We believe the AE should be the preferred procedure for ACL reconstruction in the skeletally immature,” Cordasco adds.

According to an HSS news release, during the study researchers compared two ACL reconstruction techniques for children designed to minimize contact with the growth plate, which included the AE technique and the over-the-top (OT) technique.  Researchers explain that the OT requires an open incision and does not mimic the natural ACL footprint. In the AE, researchers say, surgeons mimic the adult surgery, however the ligament is only attached to the epiphysis and does not cross into the growth plate. The AE technique is performed arthroscopically and mimics the natural ACL footprint. 

To further evaluate the techniques, researchers fixed ten human cadaver legs with intact ACLs in cement and used a robot to put each of the specimens through a series of motions in order to test knee stress and strain. The release notes that researchers then removed the ACLS and performed the same experiments to replicate ACL insufficient patients. Researchers then performed AE procedures in five the specimens and OT reconstructions in the remaining five. Each specimen received the same set of stress and stability experiments and underwent both procedures, the study reports.

The results suggest that the AE and OT performed similarly, but that the AE procedure’s performance was greater when the knee was at 15 degrees, which is commonly experienced by individuals running down the field. The researchers add that they used thicker grafts in the OT surgeries than those used in actual patients, as they wanted to use the same size grafts in both experiments. “The OT had significantly higher contract stresses at 15% of flexion compared to the AE. This is important because most field and court sports involve knee function close to this position,” Cordasco explains.

HSS adds that the study will be presented today at the annual meeting of the American Orthopedic Society for Sports Medicine (AOSSM), Baltimore, Md.

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Source: HSS