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Document Title: Behr-AJSM-Nov01.shtml
Article Title: The Relationship of the Femoral Origin of the Anterior Cruciate Ligament and the Distal Femoral Physeal Plate in the Skeletally Immature Knee: An Anatomic Study
Authors: Christopher T. Behr, MD, Hollis G. Potter, MD and George A. Paletta, Jr, MD
Publication: American Journal of Sports Medicine
Date: November 2001
Volume 29, pages 781-787
Keywords: pediatric ACL, skeletal immaturity, skeletally immature, cadaver-type study.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: This cadaver-type study discusses the relationship between the ACL's femoral origin ACL to distal femoral physeal plate in the immature knee. The authors warn that when an over-the-top femoral ACL-graft placement is used, care must be taken to avoid the femoral growth plate.
ABSTRACT
We defined the anatomic relationship of the anterior cruciate ligament femoral origin to the distal femoral physis in the skeletally immature knee with use of 12 fresh-frozen human fetal specimens (ages, 20 to 36 weeks). Each specimen underwent magnetic resonance imaging, was dissected free of soft tissue, sectioned in the sagittal plane, and stained. The spatial relationship of 1) the epiphyseal side of the physeal proliferative zone to the nearest point of bony attachment of the anterior cruciate ligament and 2) the origin of the anterior cruciate ligament to the over-the-top position were measured. The same measurements were made in 13 skeletally immature knees (ages, 5 to 15 years). We found that the femoral origin of the fetal anterior cruciate ligament developed as a confluence of ligament fibers with periosteum at 20 weeks, vascular invasion into the epiphysis at 24 weeks, and establishment of a secure epiphyseal attachment by 36 weeks. In the fetus, the distance from the anterior cruciate ligament femoral origin to the epiphysis was 2.66 ± 0.18 mm (range, 2.34 to 2.94). There was no significant change in this distance in adolescent specimens (2.92 ± 0.68 mm; range, 2.24 to 3.62). The over-the-top position was at the level of the distal femoral physis.
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