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Saturday, March 3, 2001

ACL reconstruction in children has dangers

Anterior cruciate ligament (ACL) reconstruction in children is controversial because of the potential for physeal injury. The study in poster exhibit 121 reviewed MRI images of the tibial physis and its relationship to standard ACL drill holes.

The investigators said recent studies have advocated early surgical intervention for children with ACL injury to minimize secondary meniscal injury and knee instability. This study illustrates that ACL reconstruction in children using tibial drill holes has the potential to violate a large portion of the proximal tibial physis. In order to minimize the injury to the tibial physis, the drill hole should start more inferior and medial on the crest of the tibia, and with a steeper angle of inclination.

MRI images of 30 pediatric knees were reviewed. The average age was 11 years (range: 10 to 14). These images were analyzed with a superimposed tibial drill hole used for ACL reconstruction. The images were reviewed for potential injury to the apophyseal and epiphyseal regions of the proximal tibial physis. The investigators said the standard tibial drill hole used in ACL reconstruction is nearly parallel to the posterior edge of the apophysis, and can result in the removal of a large volume of the apophysis, the apophyseal portion of the physis, and the epiphysis. Review of the images demonstrated that alterations in drill hole placement can minimize the area of damage to the apophysis and physis. The drill hole should be placed with a steeper angle of inclination, a more medial starting point and a more inferior starting point. A smaller diameter drill hole will also minimize the potential injury to the physis.

Coauthors of the study are Kevin G. Shea, MD, department of orthopaedics, University of Utah; Peter Apel, MD; and Larry D. Showalter, MD, all of Boise, Idaho.

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Last modified 15/February/2001 by IS