A randomized trial on transphyseal vs. physeal-sparing reconstruction in skeletally immature patients: functional outcomes and safety considerations

Reconstruction of the Anterior Cruciate Ligament (ACL) in Skeletally Immature Patients (SIP) poses challenges due to anatomical and developmental factors. This randomized controlled trial evaluated the Functional Recovery (FR) of pediatric patients undergoing ACL Reconstruction (ACLR), comparing Transphyseal Reconstruction (TPR) and physeal-sparing reconstruction (PSR). Forty-three young athletes (mean age 14.1 ± 2.3 years), including 29 boys and 14 girls, were randomized to TPR (n=23) or PSR (n=20). FR was assessed by using the Pediatric International Knee Documentation Committee (Pedi-IKDC) questionnaire at baseline, 8 months, and 12 months post-surgery. At the 12-month follow-up, the TPR group demonstrated a significantly greater improvement in Pedi-IKDC scores, with a 66.95% increase compared to 56.73% in the PSR group, reflecting notable differences in knee function between the groups at both 8 and 12 months (p < 0.001). Additionally, 80% of participants in the TPR group returned to sports, with 56% resuming limited activities, while the PSR group exhibited a slower recovery trajectory. These preliminary findings indicate that TPR provides superior FR and a faster return to sports compared to PSR, underscoring the importance of tailored rehabilitation protocols and long-term follow-up to optimize outcomes in SIP.