MRI assessment of growth disturbances after ACL reconstruction in children with open growth plates–Prospective multicenter study of 100 patients - 14/11/18
, Loic Geffroy c, Henri Robert d, Matthieu Sanchez e, Jonathan Curado f, Franck Chotel g, Nicolas Lefevre h, iFrench Arthroscopic Societyj
Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
Artículo gratuito.
Conéctese para beneficiarse!
Abstract |
Introduction |
We were interested in the consequences of anterior cruciate ligament (ACL) reconstruction on the growth plates and the impact on growth in children with open growth plates. The primary objective was related to growth disturbances with the null hypothesis being that ACL reconstruction in open growth plates does not cause any. The secondary objective related to the presence of physis lesions on MRI, with the null hypothesis being that ACL reconstruction in open growth plates does not induce any.
Material and Methods |
In the context of a 2017 SFA symposium on ACL reconstruction with open growth plates, we conducted a prospective multicenter study with 2 years’ follow-up. The study enrolled 100 patients; 71 were available for analysis. Four reconstruction techniques were used: semitendinosus-gracilis (STG), short graft (SG), quadriceps tendon (QT) and fascia lata (FL). MRI was used to look for growth disturbances as evidenced by deviation of the Harris lines or modification of the physis and diaphysis angles. Physis lesions were determined on MRI based on the presence of physeal bone bridges (PBB).
Results |
No growth disturbances were found. However, PBBs were found in 14 patients (20%). At the femur, the relative risk (RR) was higher when a STG graft was used (RR=2.1) and the tunnel diameter was≥9mm (RR=1.7). Epiphyseal fixation had a higher risk than transphyseal fixation (RR=1.6 vs. 1.2). At the tibia, the RR was higher when a QT graft was used (RR=3.6), when screw fixation was performed (RR=3.7) or when the graft did not fill the tunnel sufficiently (RR=1.5).
Discussion |
The absence of growth disturbances after 2 years’ follow-up validates the possibility of ACL reconstruction with open growth plates, including with transphyseal techniques. The presence of small growth plate lesions such as bone bridges means that precautions should be taken with respect to tunnel trajectory, tunnel diameter, graft and tunnel diameter matching and graft fixation.
Level of evidence |
III, prospective cohort study.
El texto completo de este artículo está disponible en PDF.Keywords : MRI, ACL reconstruction, Children, Adolescent, Physis, Growth disturbance
Esquema
Vol 104 - N° 8S
P. S175-S181 - décembre 2018 Regresar al número
Artículo precedente
- Conservative management of anterior cruciate ligament injury in paediatric population: About 53 patients
- Anya Madelaine, Gaspard Fournier, Elliot Sappey-Marinier, Thomas Madelaine, Romain Seil, Nicolas Lefevre, Franck Chotel, French Arthroscopic Society g
- Return to sport and re-tears after anterior cruciate ligament reconstruction in children and adolescents
- Loïc Geffroy, Nicolas Lefevre, Camille Thevenin-Lemoine, Antoine Peyronnet, Walid Lakhal, Jean Marie Fayard, Franck Chotel, the French Arthroscopy Society i
Bienvenido a EM-consulte, la referencia de los profesionales de la salud.