ACL reconstruction in 11 children using the Clocheville surgical technique: Objective and subjective evaluation

IntroductionThe 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 methodsEleven patients with a mean age of 13.5 years were seen at a mean 2.1 years of follow-up. They underwent objective clinical tests (GNRB® arthrometer and CON-TREX® dynamometer) as well as subjective questionnaires (IKDC and KOOS).ResultsNo significant difference was found between the healthy knee and the operated knee for either the GNRB® at 134 N (P = 0.79) or at 200 N (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.DiscussionThis 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 +0.4 mm 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.Level of evidenceIV.