ACL Surgery in Growing Athletes: Is There a Risk to the Growth Plate?

Performing ACL (anterior cruciate ligament) reconstruction in young patients is always a delicate decision. Surgeons must balance the need to restore knee stability with the risk of affecting the growth plates, which can lead to long-term issues like limb length differences or angular deformities.

A recent study led by Mahsa Sarrami, Dr Payam Tarassoli, Young Ping Lim, and Dr Alex Nicholls from the Sydney Orthopaedic Research Institute takes a closer look at one of these concerns: the formation of tibial physeal bars following transphyseal ACL reconstruction in growing adolescents.

Their research, published in the Journal of Clinical Orthopaedics and Trauma (Elsevier), offers some reassuring news for surgeons and families alike.

What Was the Study About?

The team assessed tibial and femoral growth plate (physis) changes in young patients one year after undergoing ACL reconstruction using the transphyseal technique, where the surgical tunnel passes through the growth plate.

To assess this, they used:

• High-resolution 3T MRI to detect subtle changes in bone and cartilage

• A validated bone age atlas to determine skeletal maturity

• A cohort of 48 eligible patients from a larger group of 142, with an average age of 14.1 years in males and 13.9 years in females

What Did They Find?

• The incidence of tibial physeal bar formation was low, only 4.2% of cases.

• No femoral physeal bars were found.

• None of the bars caused angular deformity or limb length discrepancy, which are the primary long-term concerns.

• In many cases, central physiological closure of the tibial physis (a normal part of growth) was observed and could easily be mistaken for a bar on imaging.

Why This Matters

These findings provide important reassurance for parents, patients, and clinicians considering ACL surgery in skeletally immature athletes. While transphyseal ACL reconstruction is not risk-free, the incidence of serious growth-related complications appears low when performed carefully and followed up with high-quality imaging.

The study also underscores the importance of accurate interpretation of growth plate changes on MRI, particularly distinguishing between normal closure and true physeal bar formation.

Conclusion

ACL injuries in children and teens are increasing, especially with the rise in early sports specialisation. This study helps inform safer surgical decisions by showing that with proper technique and monitoring, transphyseal ACL reconstruction carries a low risk of growth plate damage.

It also highlights the strength of collaborative clinical research in shaping better care for young athletes.

Read the Full Study

You can access the full article in the Journal of Clinical Orthopaedics and Trauma via Elsevier: Read it here