Micheli Anterior Cruciate Ligament Reconstruction in Skeletally Immature Youths: A Retrospective Case Series With a Mean 3-Year Follow-up.

BACKGROUND: The management of anterior cruciate ligament (ACL) tears in the skeletally immature patient remains controversial. Outcomes on a physeal-sparing technique using the iliotibial band for combined intra-articular and extra-articular ACL reconstruction, called the Micheli technique, have been described and reported by the original authors. PURPOSE: To evaluate the clinical outcomes of a physeal-sparing technique using the iliotibial band for combined intra-articular and extra-articular ACL reconstruction. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 2005 and 2011, all patients who underwent Micheli ACL reconstruction performed by a single surgeon were identified. A minimum of 3 years' growth remaining was a prerequisite for Micheli reconstruction. Patients were excluded if postoperative follow-up was less than 1 year. Patients were evaluated for functional outcomes, satisfaction, graft survival, radiographic and clinical evidence of growth disturbance, and the need for additional procedures. RESULTS: Twenty-one patients (22 knees) met the inclusion criteria for this study. The mean age at the time of surgery was 11.8 years (range, 9.9-14.0 years). All patients were male. There were 4 concomitant meniscal repairs and 5 partial meniscectomies performed. All patients (100%) completed follow-up at a mean duration of 3.0 years (range, 1.0-6.9 years). Overall, 6 knees (27%) underwent reoperation. Of these, 3 knees (14%) underwent revision ACL surgery: 2 revision reconstructions at 2.8 and 4.0 years postoperatively and 1 graft shrinkage at 4.7 months postoperatively. Three knees (14%) underwent subsequent meniscal procedures, including 2 partial meniscectomies and 1 meniscal repair. Of the 19 knees that did not require revision ACL surgery, the median patient satisfaction score was 10 (range, 9-10). The mean Pediatric International Knee Documentation Committee score was 96.5 ± 2.9, and the mean Lysholm score was 95.0 ± 6.1. The median preinjury Tegner activity level was 8 (range, 6-10), and the median postoperative Tegner activity level was 8 (range, 6-10). Of the 19 knees that did not require revision ACL surgery, all had a normal Lachman test result, with a firm endpoint and normal pivot shift. At follow-up, 53% of knees had closed physes. There were no angular deformities or limb-length discrepancies. CONCLUSION: At a mean 3-year follow-up, the study findings confirmed excellent functional outcomes, a low ACL revision rate, and no growth disturbances. Patients returned to their preoperative activity level after reconstruction. This procedure offers a safe and effective ACL reconstruction option in children with several years of growth remaining.

Association between acromial index and outcomes following arthroscopic repair of full-thickness rotator cuff tears.

BACKGROUND: The purposes of this study were to evaluate the association between the acromial index and full-thickness rotator cuffs and to determine if the size of the acromial index was associated with outcomes in a cohort of patients who had had arthroscopic repair of full-thickness rotator cuff tears. METHODS: The acromial index was calculated for three groups by individual researchers: 115 patients (120 shoulders) who had arthroscopically repaired full-thickness rotator cuff tears without osteoarthritis (Group I); sixty-four patients (sixty-eight shoulders) who had intact rotator cuffs with osteoarthritis (Group II); and twenty-one patients (twenty-one shoulders) who had intact rotator cuffs, without osteoarthritis, and were managed for other pathology (Group III). The acromial index is the distance between the glenoid plane and the lateral border of the acromion divided by the distance between the glenoid plane and the lateral aspect of the humeral head. Ninety-two patients (ninety-three shoulders) from Group I met inclusion criteria for subjective follow-up. Minimum two-year subjective data were obtained on 86% (seventy-nine patients [eighty shoulders]) of these ninety-two patients to determine the association of the acromial index on surgical outcomes. Surgical factors were also analyzed. Significance was set at p < 0.05. RESULTS: The acromial index demonstrated high intraobserver agreement (kappa, 0.960; 95% confidence interval, 0.940 to 0.984) and high interobserver agreement (kappa, 0.960; 95% confidence interval, 0.922 to 0.979). The mean acromial index (and standard deviation) was 0.687 ± 0.08 for Group I, 0.685 ± 0.11 for Group II, and 0.694 ± 0.07 for Group III. No significant differences were found. At an average duration of follow-up of 3.0 years (range, 2.0 to 5.4 years), the mean American Shoulder and Elbow Surgeons scores improved from 59 to 93 points (p = 0.001) in the seventy-nine patients from Group I who had minimum two-year duration of subjective follow-up. The mean postoperative scores were 10.4 points (range, 0 to 54.5 points) for the Quick Disabilities of the Arm, Shoulder and Hand Outcome Measure and 9.2 points (on a scale of 1 to 10 points) for patient satisfaction. When the patients with a large acromial index (>0.682) were compared with those with a small acromial index (≤ 0.682), the patients in the former group had a greater likelihood of having a tear involving two or more rotator cuff tendons (p = 0.017), required more anchors to achieve repair (p = 0.007), had slightly lower patient satisfaction scores (mean, 8.9 compared with 9.5 points; p = 0.055) and Short Form-12 Physical Component Summary scores (mean, 49.1 compared with 55.2 points; p = 0.04), and had higher Quick Disabilities of the Arm, Shoulder and Hand scores (mean, 12.9 compared with 7.4 points; p = 0.042). CONCLUSIONS: An association between the size of the acromial index and that of full-thickness rotator cuff tears was not confirmed; however, a larger acromial index was associated with an increased number of tendons torn and anchors used for repair. In addition, patients with a larger acromial index had more disability as recorded by the Quick Disabilities of the Arm, Shoulder and Hand Outcome Measure and poorer physical health as measured by the Short Form-12 Physical Component Summary score.