ACL reconstruction in 11 children using the Clocheville surgical technique: Objective and subjective evaluation - 09/05/16

Doi : 10.1016/j.otsr.2016.03.007

M. Severyns ^a, G. Lucas ^a, R. Jallageas ^b, S. Briand ^c, G. Odri ^c, B. Fraisse ^a, S. Marleix ^a, P. Rochcongar ^b, P. Violas ^a,^⁎
^a Service de chirurgie pédiatrique, hôpital Sud, CHU de Rennes, boulevard de Bulgarie, 35200 Rennes, France
^b Département de médecine du sport, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35200 Rennes, France
^c Clinique chirurgicale d’orthopédie et traumatologie, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes, France

^⁎Corresponding author. Tel.: +33 2 99 28 43 21.

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Abstract

Introduction

The over-the-top position of the femoral metaphyseal tunnel during extraphyseal ligament reconstruction of the anterior cruciate ligament (ACL) according to Clocheville may be responsible for negative anisometry. Until now, the follow-up of children operated using this pediatric technique was limited to screening for iatrogenic epiphysiodesis and the search for postoperative clinical instability. The objective of this study was to measure residual laxity using objective tests, to quantify muscle recovery, and to evaluate the quality of life of these patients in terms of the sports activities.

Material and methods

Eleven patients with a mean age of 13.5years were seen at a mean 2.1years of follow-up. They underwent objective clinical tests (GNRB^® arthrometer and CON-TREX^® dynamometer) as well as subjective questionnaires (IKDC and KOOS).

Results

No significant difference was found between the healthy knee and the operated knee for either the GNRB^® at 134N (P=0.79) or at 200N (P=0.98). The CON-TREX^® system allowed us to measure a median percentage of quadriceps recovery of 80.7% (range, 52.2–114.5) in terms of muscle power (60°/s) and 81.2% (range, 51.6–109.6) for muscle response (180°/s). The median subjective IKDC score was 94.73/100 (range, 73.68–98.93); 72.7% of the patients resumed competitive sports.

Discussion

This study's lack of statistical power did not show a significant difference in terms of residual laxity at rest of GNRB^® transplants, while a mean differential of +0.4mm was observed. Although pediatric transphyseal ligament reconstruction techniques are increasingly used, the Clocheville technique remains, in our opinion, an attractive surgical alternative in the youngest subjects, with no major risk of iatrogenic epiphysiodesis even though it is theoretically anisometric.