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No bone tunnel enlargement in patients with open growth plates after transphyseal ACL reconstruction

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Bone tunnel enlargement after ACL reconstruction has been described extensively in adults. However, little is known about this phenomenon in patients with open growth plates. Thus, the goals of the current study were to evaluate changes in bone tunnel size in patients with open growth plates after transphyseal ACL reconstruction with suspensory fixation and to correlate tunnel size with clinical outcome after medium-term follow-up. Fourteen patients with open growth plates were included that underwent primary transphyseal ACL reconstruction using hamstrings autografts and suspensory fixation. Mean follow-up time was 7 years. At the time of follow-up, MRIs of the operated knee were performed, and outcome was assessed using KOS-ADLS, Lysholm score, IKDC Subjective Knee Form score, Knee Examination Form score, and KT-1000 measurements. On MRI, the cross-sectional area of the bone tunnels was assessed using special axial cuts perpendicular to the axes of the tunnels. Two orthopaedic surgeons and two radiologists analysed the MRIs. Change in bone tunnel size from surgery to follow-up was calculated. No significant changes in bone tunnel size from surgery to follow-up were found. Regarding outcome measures, KOS-ADLS averaged 95%, Lysholm Score averaged 96 points, IKDC Subjective Knee Form averaged 95%, IKDC Knee Examination Form scores were 8A, 5B, 1C, and KT-1000 measurements averaged 1.8 ± 1.4 mm. No significant correlations were found between tunnel size at follow-up and outcome measures. Based on our study, bone tunnel enlargement does not occur in patients who have open growth plates and undergo ACL reconstruction using suspensory fixation.

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References

  1. Anderson AF (2004) Transepiphyseal replacement of the anterior cruciate ligament using quadruple hamstring grafts in skeletally immature patients. J Bone Joint Surg Am 86-A(Suppl 1):201–209

    PubMed  Google Scholar 

  2. Asik M, Sen C, Tuncay I, Erdil M, Avci C, Taser OF (2007) The mid- to long-term results of the anterior cruciate ligament reconstruction with hamstring tendons using Transfix technique. Knee Surg Sports Traumatol Arthrosc 15:965–972

    Article  PubMed  Google Scholar 

  3. Baumfeld JA, Diduch DR, Rubino LJ, Hart JA, Miller MD, Barr MS, Hart JM (2008) Tunnel widening following anterior cruciate ligament reconstruction using hamstring autograft: a comparison between double cross-pin and suspensory graft fixation. Knee Surg Sports Traumatol Arthrosc 16:1108–1113

    Article  PubMed  Google Scholar 

  4. Bizzini M, Gorelick M (2007) Development of a German version of the knee outcome survey for daily activities. Arch Orthop Trauma Surg 127:781–789

    Article  CAS  PubMed  Google Scholar 

  5. Buchner M, Schmeer T, Schmitt H (2007) Anterior cruciate ligament reconstruction with quadrupled semitendinosus tendon—minimum 6 year clinical and radiological follow-up. Knee 14:321–327

    Article  PubMed  Google Scholar 

  6. Buelow JU, Siebold R, Ellermann A (2002) A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: extracortical versus anatomical fixation. Knee Surg Sports Traumatol Arthrosc 10:80–85

    Article  PubMed  Google Scholar 

  7. Clatworthy MG, Annear P, Bulow JU, Bartlett RJ (1999) Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts. Knee Surg Sports Traumatol Arthrosc 7:138–145

    Article  CAS  PubMed  Google Scholar 

  8. Edwards TB, Greene CC, Baratta RV, Zieske A, Willis RB (2001) The effect of placing a tensioned graft across open growth plates. A gross and histologic analysis. J Bone Joint Surg Am 83:725–734

    PubMed  Google Scholar 

  9. Fauno P, Kaalund S (2005) Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: a prospective randomized study. Arthroscopy 21:1337–1341

    Article  PubMed  Google Scholar 

  10. Gaulrapp HM, Haus J (2006) Intraarticular stabilization after anterior cruciate ligament tear in children and adolescents: results 6 years after surgery. Knee Surg Sports Traumatol Arthrosc 14:417–424

    Article  CAS  PubMed  Google Scholar 

  11. Guzzanti V, Falciglia F, Stanitski CL (2003) Physeal-sparing intraarticular anterior cruciate ligament reconstruction in preadolescents. Am J Sports Med 31:949–953

    PubMed  Google Scholar 

  12. Guzzanti V, Falciglia F, Stanitski CL (2003) Preoperative evaluation and anterior cruciate ligament reconstruction technique for skeletally immature patients in Tanner stages 2 and 3. Am J Sports Med 31:941–948

    PubMed  Google Scholar 

  13. Iorio R, Vadalà A, Argento G, Di Sanzo V, Ferretti A (2007) Bone tunnel enlargement after ACL reconstruction using autologous hamstring tendons: a CT study. Int Orthop 31:49–55

    Article  PubMed  Google Scholar 

  14. Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613

    CAS  PubMed  Google Scholar 

  15. Irrgang JJ, Snyder-Mackler L, Wainner RS, Fu FH, Harner CD (1998) Development of a patient-reported measure of function of the knee. J Bone Joint Surg Am 80:1132–1145

    CAS  PubMed  Google Scholar 

  16. Ishibashi Y, Rudy TW, Livesay GA, Stone JD, Fu FH, Woo SL (1997) The effect of anterior cruciate ligament graft fixation site at the tibia on knee stability: evaluation using a robotic testing system. Arthroscopy 13:177–182

    Article  CAS  PubMed  Google Scholar 

  17. Janarv PM, Wikström B, Hirsch G (1998) The influence of transphyseal drilling and tendon grafting on bone growth: an experimental study in the rabbit. J Pediatr Orthop 18:149–154

    Article  CAS  PubMed  Google Scholar 

  18. Jo H, Jun DS, Lee DY, Lee SH, Seong SC, Lee MC (2004) Tibial tunnel area changes following arthroscopic anterior cruciate ligament reconstructions with autogenous patellar tendon graft. Knee Surg Sports Traumatol Arthrosc 12:311–316

    Article  PubMed  Google Scholar 

  19. Kocher MS, Garg S, Micheli LJ (2005) Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescents. J Bone Joint Surg Am 87:2371–2379

    Article  PubMed  Google Scholar 

  20. Kocher MS, Garg S, Micheli LJ (2006) Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescents surgical technique. J Bone Joint Surg Am 88(Suppl 1 Pt 2):283–293

    Article  PubMed  Google Scholar 

  21. Kocher MS, Saxon HS, Hovis WD, Hawkins RJ (2002) Management and complications of anterior cruciate ligament injuries in skeletally immature patients: survey of the Herodicus Society and The ACL Study Group. J Pediatr Orthop 22:452–457

    Article  PubMed  Google Scholar 

  22. Kocher MS, Smith JT, Zoric BJ, Lee B, Micheli LJ (2007) Transphyseal anterior cruciate ligament reconstruction in skeletally immature pubescent adolescents. J Bone Joint Surg Am 89:2632–2639

    Article  PubMed  Google Scholar 

  23. Koman JD, Sanders JO (1999) Valgus deformity after reconstruction of the anterior cruciate ligament in a skeletally immature patient. A case report. J Bone Joint Surg Am 81:711–715

    CAS  PubMed  Google Scholar 

  24. Liddle AD, Imbuldeniya AM, Hunt DM (2008) Transphyseal reconstruction of the anterior cruciate ligament in prepubescent children. J Bone Joint Surg Br 90:1317–1322

    Article  CAS  PubMed  Google Scholar 

  25. Lipscomb AB, Anderson AF (1986) Tears of the anterior cruciate ligament in adolescents. J Bone Joint Surg Am 68:19–28

    CAS  PubMed  Google Scholar 

  26. Matava MJ, Siegel MG (1997) Arthroscopic reconstruction of the ACL with semitendinosus-gracilis autograft in skeletally immature adolescent patients. Am J Knee Surg 10:60–69

    CAS  PubMed  Google Scholar 

  27. McCarroll JR, Rettig AC, Shelbourne KD (1988) Anterior cruciate ligament injuries in the young athlete with open physes. Am J Sports Med 16:44–47

    Article  CAS  PubMed  Google Scholar 

  28. McIntosh AL, Dahm DL, Stuart MJ (2006) Anterior cruciate ligament reconstruction in the skeletally immature patient. Arthroscopy 22:1325–1330

    Article  PubMed  Google Scholar 

  29. Meller R, Kendoff D, Hankemeier S, Jagodzinski M, Grotz M, Knobloch K, Krettek C (2008) Hindlimb growth after a transphyseal reconstruction of the anterior cruciate ligament: a study in skeletally immature sheep with wide-open physes. Am J Sports Med 36:2437–2443

    Article  PubMed  Google Scholar 

  30. Meyer RA, Meyer MH, Tenholder M, Wondracek S, Wasserman R, Garges P (2003) Gene expression in older rats with delayed union of femoral fractures. J Bone Joint Surg Am 85-A:1243–1254

    PubMed  Google Scholar 

  31. Moksnes H, Engebretsen L, Risberg MA (2008) Performance-based functional outcome for children 12 years or younger following anterior cruciate ligament injury: a two to nine-year follow-up study. Knee Surg Sports Traumatol Arthrosc 16:214–223

    Article  PubMed  Google Scholar 

  32. Nebelung W, Becker R, Merkel M, Ropke M (1998) Bone tunnel enlargement after anterior cruciate ligament reconstruction with semitendinosus tendon using endobutton fixation on the femoral side. Arthroscopy 14:810–815

    Article  CAS  PubMed  Google Scholar 

  33. Nordentoft EL (1969) Experimental epiphyseal injuries. Grading of traumas and attempts at treating traumatic epiphyseal arrest in animals. Acta Orthop Scand 40:176–192

    Article  CAS  PubMed  Google Scholar 

  34. Ono T, Wada Y, Takahashi K, Tsuchida T, Minamide M, Moriya H (1998) Tibial deformities and failures of anterior cruciate ligament reconstruction in immature rabbits. J Orthop Sci 3:150–155

    Article  CAS  PubMed  Google Scholar 

  35. Peyrache MD, Djian P, Christel P, Witvoet J (1996) Tibial tunnel enlargement after anterior cruciate ligament reconstruction by autogenous bone-patellar tendon-bone graft. Knee Surg Sports Traumatol Arthrosc 4:2–8

    Article  CAS  PubMed  Google Scholar 

  36. Pressman AE, Letts RM, Jarvis JG (1997) Anterior cruciate ligament tears in children: an analysis of operative versus nonoperative treatment. J Pediatr Orthop 17:505–511

    Article  CAS  PubMed  Google Scholar 

  37. Sallis JF (1991) Self-report measures of children’s physical activity. J Sch Health 61:215–219

    Article  CAS  PubMed  Google Scholar 

  38. Schultz WR, McKissick RC, DeLee JC (2007) Tibial tunnel widening after hamstring tendon anterior cruciate ligament reconstruction: the effect of supplemental aperture fixation with autogenous bone cores. Am J Sports Med 35:1725–1730

    Article  PubMed  Google Scholar 

  39. Seil R, Pape D, Kohn D (2008) The risk of growth changes during transphyseal drilling in sheep with open physes. Arthroscopy 24:824–833

    Article  PubMed  Google Scholar 

  40. Seon JK, Song EK, Yoon TR, Park SJ (2005) Transphyseal reconstruction of the anterior cruciate ligament using hamstring autograft in skeletally immature adolescents. J Korean Med Sci 20:1034–1038

    Article  PubMed  Google Scholar 

  41. Sethe S, Scutt A, Stolzing A (2006) Aging of mesenchymal stem cells. Ageing Res Rev 5:91–116

    Article  CAS  PubMed  Google Scholar 

  42. Siebold R (2007) Observations on bone tunnel enlargement after double-bundle anterior cruciate ligament reconstruction. Arthroscopy 23:291–298

    Article  PubMed  Google Scholar 

  43. Simonian PT, Metcalf MH, Larson RV (1999) Anterior cruciate ligament injuries in the skeletally immature patient. Am J Orthop 28:624–628

    CAS  PubMed  Google Scholar 

  44. Stadelmaier DM, Arnoczky SP, Dodds J, Ross H (1995) The effect of drilling and soft tissue grafting across open growth plates. A histologic study. Am J Sports Med 23:431–435

    Article  CAS  PubMed  Google Scholar 

  45. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    PubMed  Google Scholar 

  46. Wilson TC, Kantaras A, Atay A, Johnson DL (2004) Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med 32:543–549

    Article  PubMed  Google Scholar 

  47. Wolf RS, Lemak LJ (2002) Revision anterior cruciate ligament reconstruction surgery. J South Orthop Assoc 11:25–32

    PubMed  Google Scholar 

  48. Zysk SP, Fraunberger P, Veihelmann A, Dörger M, Kalteis T, Maier M, Pellengahr C, Refior HJ (2004) Tunnel enlargement and changes in synovial fluid cytokine profile following anterior cruciate ligament reconstruction with patellar tendon and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 12:98–103

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We wish to thank M. Röpke, M.D. and W. Nebelung, M.D. for their support.

Conflict of interest

No potential conflict of interest declared.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany

    S. Kopf & C. Stärke

  2. Department of Radiology, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany

    J.-P. Schenkengel & G. Wieners

  3. Department of Orthopaedic Surgery and Traumatology, City Hospital of Brandenburg, Hochstrasse 26, 14770, Brandenburg, Germany

    R. Becker

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  1. S. Kopf
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  2. J.-P. Schenkengel
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Correspondence to R. Becker.

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Kopf, S., Schenkengel, JP., Wieners, G. et al. No bone tunnel enlargement in patients with open growth plates after transphyseal ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18, 1445–1451 (2010). https://doi.org/10.1007/s00167-009-1041-4

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  • DOI: https://doi.org/10.1007/s00167-009-1041-4

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