University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, 22 S Greene Street, Baltimore, MD 21201, USA.
Am J Sports Med. 2013 Jul;41(7):1579-85. doi: 10.1177/0363546513486770. Epub 2013 May 6.
Questions have been raised concerning the height of the tibial epiphysis as an important factor related to the safety of intra-articular anterior cruciate ligament (ACL) reconstruction in skeletally immature knees. However, normal values for this parameter have yet to be established on cross-sectional magnetic resonance imaging (MRI).
To determine normal values for the height of the tibial epiphysis and width of the lateral femoral condylar epiphysis in children and adolescents by use of MRI.
Cross-sectional study; Level of evidence, 3.
An electronic search was conducted for pediatric knee MRI examinations at the authors' institution from August 2007 to July 2011. The height of the tibial epiphysis was determined on the sagittal T1-weighted image best containing the ACL footplate. Lateral femoral condylar width was recorded on coronal proton-density-weighted images. The intraclass correlation coefficient (ICC) was calculated to determine interobserver agreement. Knees were stratified by age into 2 groups based on potential risk of iatrogenic growth plate injury: Group 1 consisted of boys younger than 13 years (range, 7-12 years) and girls younger than 12 years (range, 10-11 years); group 2 consisted of boys between the ages of 13 and 16 years and girls between the ages of 12 and 14 years. Each cohort was further stratified by sex.
Group 1 consisted of 17 boys (mean age, 10.4 years) and 5 girls (mean age, 10.8 years), and group 2 contained 23 boys (mean age, 14.4 years) and 14 girls (mean age, 13.7 years). There was a total of 59 knees. No difference was found for average tibial epiphyseal height between group 1 (15.26 ± 1.25 mm) and group 2 (15.01 ± 2.14 mm). However, there was a statistically significant difference related to sex in each cohort: boys versus girls in group 1 (15.63 ± 1.15 mm vs 14.00 ± 0.62 mm, respectively; P = .007) and boys versus girls in group 2 (16.00 ± 1.88 mm vs 13.40 ± 1.47 mm, respectively; P = .0001). The average femoral condylar width for both cohorts was greater than 28 mm where femoral tunnel location would be expected. The ICC was strong (>0.7) at tibial and femoral locations where tunnel placement would be expected.
The average height of the tibial epiphysis in both children and adolescents is 15 mm. Girls had shorter tibial epiphyses than boys, but further studies are necessary to determine whether this difference is clinically relevant. Lateral femoral condylar width in children and adolescents can be expected to be greater than 28 mm.
人们对胫骨骨骺的高度提出了疑问，认为其是与未成熟膝关节关节内前交叉韧带（ACL）重建安全性相关的重要因素。然而，在横断面磁共振成像（MRI）上，该参数的正常数值尚未确定。
利用 MRI 确定儿童和青少年胫骨骨骺高度和外侧股骨髁骨骺宽度的正常数值。
横断面研究；证据等级，3 级。
对作者所在机构 2007 年 8 月至 2011 年 7 月间的膝关节 MRI 检查进行了电子检索。在最佳包含 ACL 基板的矢状 T1 加权图像上确定胫骨骨骺的高度。在冠状质子密度加权图像上记录外侧股骨髁宽度。计算组内相关系数（ICC）以确定观察者间的一致性。根据潜在医源性生长板损伤风险，将膝关节分为 2 组：第 1 组包括小于 13 岁的男孩（7-12 岁）和小于 12 岁的女孩（10-11 岁）；第 2 组包括 13 至 16 岁的男孩和 12 至 14 岁的女孩。每个队列根据性别进一步分层。
第 1 组包括 17 名男孩（平均年龄 10.4 岁）和 5 名女孩（平均年龄 10.8 岁），第 2 组包括 23 名男孩（平均年龄 14.4 岁）和 14 名女孩（平均年龄 13.7 岁）。共有 59 个膝关节。第 1 组（15.26±1.25 mm）和第 2 组（15.01±2.14 mm）的平均胫骨骨骺高度无差异。然而，在每个队列中，性别差异均有统计学意义：第 1 组的男孩与女孩（分别为 15.63±1.15 mm 和 14.00±0.62 mm，P=.007），第 2 组的男孩与女孩（分别为 16.00±1.88 mm 和 13.40±1.47 mm，P=.0001）。两个队列的平均股骨髁宽度均大于 28 mm，预计在此处进行股骨隧道定位。在预计进行隧道放置的胫骨和股骨部位，ICC 值较强（>0.7）。
儿童和青少年的胫骨骨骺平均高度为 15 mm。女孩的胫骨骨骺比男孩短，但需要进一步研究以确定这种差异是否具有临床意义。儿童和青少年的外侧股骨髁宽度预计大于 28 mm。
