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A Study of Epiphyses in the Young Prepubescent Knee Using Magnetic Resonance Imaging: Evaluation of Parameters for Anterior Cruciate Ligament Reconstruction.

Davis DL, Chen L, Ehinger M - Orthop J Sports Med (2014)

Bottom Line: No difference was found for total tibial epiphyseal height between the 2 groups.No difference was found for average ossified tibial epiphyseal height or ossified lateral femoral condylar width between boys and girls in the younger or older cohorts.However, future studies will be necessary to determine the safety and effectiveness of this procedure in children aged <7 years.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.

ABSTRACT

Background: Questions have been raised concerning the safety of intra-articular anterior cruciate ligament (ACL) reconstruction in prepubescent children aged <7 years. However, normal values for the width of the lateral femoral condylar epiphysis and height of the tibial epiphysis have yet to be established through the use of magnetic resonance imaging (MRI).

Purpose: To determine normal values for the width of the lateral femoral condylar epiphysis and height of the tibial epiphysis at the knee in prepubescent children aged <7 years by use of MRI and to compare this age group with an older cohort of prepubescent children aged <10 years.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: An electronic search was conducted for pediatric knee MRI examinations at the authors' institution from March 2003 to March 2013. The total and ossified lateral femoral condylar widths were determined on coronal proton density-weighted images. The total and ossified tibial epiphyseal heights were recorded on the sagittal T1-weighted image best containing the ACL footplate. The intraclass correlation coefficient (ICC) was calculated to determine interobserver agreement. Knees were stratified by age into 2 groups: children between the ages of 3 and 6 years (group 1) and children between the ages of 7 and 9 years (group 2). Each cohort was further stratified by sex.

Results: Group 1 consisted of 10 children (mean age, 4.3 years) and group 2 consisted of 10 children (mean age, 8.5 years). There were a total of 20 knees. There was a statistically significant difference between groups 1 and 2 for the ossified lateral femoral condylar width where femoral tunnel location would be expected (20.00 ± 4.20 vs 26.27 ± 4.12 mm, respectively; P = .0035) and for total lateral femoral condylar width (25.57 ± 3.47 vs 29.43 ± 4.04 mm, respectively; P = .0339). No difference was found for total tibial epiphyseal height between the 2 groups. However, there was a difference between groups 1 and 2 for ossified tibial epiphyseal height (13.20 ± 1.63 vs 15.27 ± 0.94 mm, respectively; P = .0028). No difference was found for average ossified tibial epiphyseal height or ossified lateral femoral condylar width between boys and girls in the younger or older cohorts. The ICC was strong (>0.7) at femoral and tibial locations where tunnel placement would be expected.

Conclusion: Prepubescent children <7 years old have smaller knee epiphyses than older prepubescent children, and on average, present with an osseous bone stock of 20 mm for lateral femoral condylar width and 13 mm for tibial epiphyseal height. Study results suggest that children aged <7 years possess enough osseous bone stock at the lateral femoral condyle to support transepiphyseal ACL reconstruction. However, future studies will be necessary to determine the safety and effectiveness of this procedure in children aged <7 years.

Clinical relevance: ACL tears in children are more frequently being recognized by the orthopaedic community. The trend toward increasing participation in competitive and recreational sports has contributed to this phenomenon. Young patients with complete ACL tears and open growth plates often provide a management dilemma for surgeons who wish to perform reconstructive surgery.

No MeSH data available.


Related in: MedlinePlus

Sagittal T1-weighted magnetic resonance images demonstrating how tibial epiphyseal height measurements were obtained. (A) Total height, including ossified and cartilaginous anlage components (yellow line). (B) Ossified component only (blue line).
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fig1-2325967114530090: Sagittal T1-weighted magnetic resonance images demonstrating how tibial epiphyseal height measurements were obtained. (A) Total height, including ossified and cartilaginous anlage components (yellow line). (B) Ossified component only (blue line).

Mentions: Two musculoskeletal radiologists and 1 musculoskeletal radiology fellow independently and retrospectively reviewed the images on a PACS workstation. The height of the tibial epiphysis was evaluated from the sagittal T1-weighted image best containing the ACL and its tibial footplate (Figure 1).9 Two separate measurements were obtained: (1) The height of the tibial epiphysis was determined as the vertical distance from the cartilaginous attachment site at the midpoint of the ACL footplate to the proximal tibial epiphysis–physis interface and (2) the height of the ossified portion of the tibial epiphysis was also measured as the vertical distance from the superior margin of the ossified tibial epiphysis in line with the midpoint of the ACL footplate to the proximal tibial epiphysis–physis interface. In this study, we included knees that had intact ACLs or mild sprains, in order that the location of the tibial footplates could be readily identified. We did so to provide a reliable location for reproducible measurement and to provide a height of the tibial epiphysis that best correlated with the location of the native ACL footprint.


A Study of Epiphyses in the Young Prepubescent Knee Using Magnetic Resonance Imaging: Evaluation of Parameters for Anterior Cruciate Ligament Reconstruction.

Davis DL, Chen L, Ehinger M - Orthop J Sports Med (2014)

Sagittal T1-weighted magnetic resonance images demonstrating how tibial epiphyseal height measurements were obtained. (A) Total height, including ossified and cartilaginous anlage components (yellow line). (B) Ossified component only (blue line).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555595&req=5

fig1-2325967114530090: Sagittal T1-weighted magnetic resonance images demonstrating how tibial epiphyseal height measurements were obtained. (A) Total height, including ossified and cartilaginous anlage components (yellow line). (B) Ossified component only (blue line).
Mentions: Two musculoskeletal radiologists and 1 musculoskeletal radiology fellow independently and retrospectively reviewed the images on a PACS workstation. The height of the tibial epiphysis was evaluated from the sagittal T1-weighted image best containing the ACL and its tibial footplate (Figure 1).9 Two separate measurements were obtained: (1) The height of the tibial epiphysis was determined as the vertical distance from the cartilaginous attachment site at the midpoint of the ACL footplate to the proximal tibial epiphysis–physis interface and (2) the height of the ossified portion of the tibial epiphysis was also measured as the vertical distance from the superior margin of the ossified tibial epiphysis in line with the midpoint of the ACL footplate to the proximal tibial epiphysis–physis interface. In this study, we included knees that had intact ACLs or mild sprains, in order that the location of the tibial footplates could be readily identified. We did so to provide a reliable location for reproducible measurement and to provide a height of the tibial epiphysis that best correlated with the location of the native ACL footprint.

Bottom Line: No difference was found for total tibial epiphyseal height between the 2 groups.No difference was found for average ossified tibial epiphyseal height or ossified lateral femoral condylar width between boys and girls in the younger or older cohorts.However, future studies will be necessary to determine the safety and effectiveness of this procedure in children aged <7 years.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.

ABSTRACT

Background: Questions have been raised concerning the safety of intra-articular anterior cruciate ligament (ACL) reconstruction in prepubescent children aged <7 years. However, normal values for the width of the lateral femoral condylar epiphysis and height of the tibial epiphysis have yet to be established through the use of magnetic resonance imaging (MRI).

Purpose: To determine normal values for the width of the lateral femoral condylar epiphysis and height of the tibial epiphysis at the knee in prepubescent children aged <7 years by use of MRI and to compare this age group with an older cohort of prepubescent children aged <10 years.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: An electronic search was conducted for pediatric knee MRI examinations at the authors' institution from March 2003 to March 2013. The total and ossified lateral femoral condylar widths were determined on coronal proton density-weighted images. The total and ossified tibial epiphyseal heights were recorded on the sagittal T1-weighted image best containing the ACL footplate. The intraclass correlation coefficient (ICC) was calculated to determine interobserver agreement. Knees were stratified by age into 2 groups: children between the ages of 3 and 6 years (group 1) and children between the ages of 7 and 9 years (group 2). Each cohort was further stratified by sex.

Results: Group 1 consisted of 10 children (mean age, 4.3 years) and group 2 consisted of 10 children (mean age, 8.5 years). There were a total of 20 knees. There was a statistically significant difference between groups 1 and 2 for the ossified lateral femoral condylar width where femoral tunnel location would be expected (20.00 ± 4.20 vs 26.27 ± 4.12 mm, respectively; P = .0035) and for total lateral femoral condylar width (25.57 ± 3.47 vs 29.43 ± 4.04 mm, respectively; P = .0339). No difference was found for total tibial epiphyseal height between the 2 groups. However, there was a difference between groups 1 and 2 for ossified tibial epiphyseal height (13.20 ± 1.63 vs 15.27 ± 0.94 mm, respectively; P = .0028). No difference was found for average ossified tibial epiphyseal height or ossified lateral femoral condylar width between boys and girls in the younger or older cohorts. The ICC was strong (>0.7) at femoral and tibial locations where tunnel placement would be expected.

Conclusion: Prepubescent children <7 years old have smaller knee epiphyses than older prepubescent children, and on average, present with an osseous bone stock of 20 mm for lateral femoral condylar width and 13 mm for tibial epiphyseal height. Study results suggest that children aged <7 years possess enough osseous bone stock at the lateral femoral condyle to support transepiphyseal ACL reconstruction. However, future studies will be necessary to determine the safety and effectiveness of this procedure in children aged <7 years.

Clinical relevance: ACL tears in children are more frequently being recognized by the orthopaedic community. The trend toward increasing participation in competitive and recreational sports has contributed to this phenomenon. Young patients with complete ACL tears and open growth plates often provide a management dilemma for surgeons who wish to perform reconstructive surgery.

No MeSH data available.


Related in: MedlinePlus