Volumetric Injury of the Physis During Single-Bundle Anterior Cruciate Ligament Reconstruction in Children: A 3-Dimensional Study Using Magnetic Resonance Imaging
| Autor: | Jen Belzer, Kurt J. Nilsson, Peter J. Apel, Nathan L. Grimm, Kevin G. Shea, Ronald P. Pfeiffer |
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| Rok vydání: | 2009 |
| Předmět: |
Male
musculoskeletal diseases medicine.medical_specialty Anterior cruciate ligament reconstruction medicine.medical_treatment Anterior cruciate ligament Knee Injuries Arthroscopy Imaging Three-Dimensional medicine Humans Orthopedics and Sports Medicine Femur Tibia Anterior Cruciate Ligament Child Physis medicine.diagnostic_test Drill business.industry Anterior Cruciate Ligament Injuries Plastic Surgery Procedures Prognosis musculoskeletal system Magnetic Resonance Imaging Surgery medicine.anatomical_structure Child Preschool Orthopedic surgery Female business Nuclear medicine Follow-Up Studies |
| Zdroj: | Arthroscopy: The Journal of Arthroscopic & Related Surgery. 25:1415-1422 |
| ISSN: | 0749-8063 |
| Popis: | Purpose: To determine the volume of injury to the physis during anterior cruciate ligament (ACL) reconstruction in pediatric patients. Methods: Magnetic resonance imaging scans of 10 pediatric knees were converted into 3-dimensional models. Computer-aided design/computer-aided manufacturing software placed drill holes (6, 7, 8, and 9 mm in diameter) in these models, simulating tunnels used for ACL reconstruction. The software was used to calculate total physeal volume and volume of physis removed by the tunnel. The ratio of physeal volume removed to the total physeal volume was determined. Results: For 6-, 7-, 8-, and 9-mm-diameter drill holes, the mean percent of physeal volume removed/total physeal volume was 1.6%, 2.2%, 2.9%, and 3.8%, respectively, for the tibia and 2.4%, 3.2%, 4.2%, and 5.4%, respectively, for the femur. For all subjects, the volume removed was less than 7.0% for the tibia and 9.0% for the femur by use of drill holes from 6 to 9 mm. The tibial drill hole was centrally placed in all cases compared with a more peripheral drill hole placement of the femur. Conclusions: Drill hole placement during ACL reconstruction produces a zone of physeal injury. The overall volume of injury is relatively low, which reduces the risk of physeal arrest. With careful drill hole placement, the region of injury is central on the tibia, and the total volume of injury can be less than 5.0% of the physeal volume. For the femur, the total volume can be less than 5.0% as well. However, the region of injury is peripheral, which carries a higher risk of physeal arrest. Clinical Relevance: A better understanding of the relation between the ACL and physis may guide the placement of drill holes, which have a lower risk of producing physeal arrest. |
| Databáze: | OpenAIRE |
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