Document Title: Houle-CORR-Oct01.shtml
Article Title: Effects of a Tensioned Tendon Graft in a Bone Tunnel Across the Rabbit Physis
Authors: Houle, Jean-Benoit MD; Letts, Merv MD; Yang, Jianping MD
Publication: Clinical Orthopaedics and Related Research
Date: October 2001
Volume 391, pages 275-281
Keywords: pediatric ACL, delayed reconstruction, skeletal immaturity, skeletally immature, knee, risk, meniscus, activity, activity restriction, pediatric ACL reconstruction, knee degeneration due to chronic ACL deficiency, laboratory study, rabbit.

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Comments: This intriguing study shows how placing a tensioned soft-tissue graft can affect the growth plates (physes). (This is a laboratory-animal study, although the rabbit model is well-accepted with regards to orthopedic-surgery studies.)

Abstract

Children who sustain anterior cruciate disruption often are denied the standard reconstructive procedures because of the concern that drilling across the physis of the tibia and femur and compression from a tensioned graft will result in growth plate arrest. To test this concept and to assess whether a tendon placed in the tunnel would function in a manner similar to a fat graft after the resection of a physeal bar, tunnels were made across the proximal tibial physis and distal femoral physis in a group of immature rabbits. Four tunnel diameters were used from 1.95 to 3.97 mm, in three rabbits at each diameter, with patellar tendon autografts being used as the reconstruction of the anterior cruciate ligament in two of the animals. The knees were radiographed every 4 weeks, and the animals were euthanized 4 months after surgery. The surgically treated and control knees were salvaged, and each knee was examined grossly, radiographically, and histologically. Eight of the 11 animals had growth arrest of one or both physes. The larger the drill hole diameter the more marked was the deformity. The proximal tibial physis seemed to be the most vulnerable for growth arrest, occurring in eight of the knees. The insertion of a tendon did not seem to offer any protection to physeal arrest. Because of these findings, it is not recommended that tunnels involving 1% or more of the area of the physis be placed across the tibial and femoral physis to reconstruct the anterior cruciate in very skeletally immature children.

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