Volumetric Injury of the Physis During Single-Bundle Anterior Cruciate Ligament Reconstruction in Children: A 3-Dimensional Study Using Magnetic Resonance Imaging

Pediatric anterior cruciate ligament reconstruction outcomes

“…A medial drilling entry point on the tibial cortex will help avoid damage to the anterior tuberosity and subsequent genu recurvatum [37]. Risk of growth arrest exists in the peripheral portion of the distal physis/perichondrial ring of the femur [38], so a femoral tunnel exiting in this area is likely best avoided.…”

Transphyseal ACL Reconstruction in Skeletally Immature Patients: Does Independent Femoral Tunnel Drilling Place the Physis at Greater Risk Compared to Transtibial Drilling?

“…However, in skeletally immature patients, utilizing an independent drilling technique may result in the femoral tunnel being placed more eccentrically across the distal femoral physis, exiting closer to the perichondrial ring, and potentially drilling across a larger area of the physis, thus increasing the potential risk of physeal damage. 34 The purpose of this study was to evaluate differences in the radiographic pattern of physeal involvement in a cohort of pediatric patients who underwent transphyseal ACL reconstruction utilizing 2 different femoral tunnel drilling techniques: transtibial or independent. We hypothesized that tunnels created via an independent femoral drilling technique would be more obliquely oriented and more eccentrically placed across the distal femoral physis compared with the transtibial technique.…”

Volumetric Damage to the Femoral Physis During Double-Bundle Posterior Cruciate Ligament Reconstruction: A Magnetic Resonance Imaging Computer Modeling Study

“…Recent research on ACL reconstruction techniques in skeletally immature patients has documented the increased volume of physeal damage in DB versus single-bundle (SB) reconstructive techniques. 8,9 Physeal damage also appears to be more of a clinical concern on the femoral side, as opposed to the tibial side, during ACL reconstruction. 8 Although anatomic studies are commonly performed in adult patients, 12 pediatric cadaver availability is very restricted, making anatomic studies on these young patients very difficult.…”

“…8,9 Physeal damage also appears to be more of a clinical concern on the femoral side, as opposed to the tibial side, during ACL reconstruction. 8 Although anatomic studies are commonly performed in adult patients, 12 pediatric cadaver availability is very restricted, making anatomic studies on these young patients very difficult. 15 For this reason, other research has relied on magnetic resonance imaging (MRI) and computer-generated models of the pediatric knee.…”

“…6,7 Although ACL reconstruction is performed in young patients, it is recognized that younger patients have greater residual growth and, thus, the greatest potential for significant growth complications after surgery. 8,9 Recent studies have also described different repair and reconstruction techniques for PCL injuries in skeletally immature patients, which have included techniques that use drill holes in the distal femur and proximal tibia. 10,11 Although anatomic 12 and biomechanical studies 13,14 have suggested that double-bundle (DB) PCL reconstruction may produce better outcomes, this type of procedure, if performed in skeletally immature patients, may carry a great risk of physeal injury.…”