Sarrami Mahsa, Tarassoli Payam, Lim Yoong Ping, Nicholls Alex
Sydney Orthopaedic Research Institute, St Leonards, Australia.
The Children's Hospital at Westmead, Australia.
J Orthop. 2025 Mar 18;63:135-140. doi: 10.1016/j.jor.2025.03.007. eCollection 2025 May.
INTRODUCTION: Transphyseal anterior cruciate ligament reconstruction (ACLR) is associated with a risk of angular limb deformity and limb length discrepancy particularly when there is a significant period of growth remaining.Previous studies on the effects of transphyseal ACLR have used inconsistent methodology to estimate bone age, and therefore subjects may have underestimated the effect on the physis.This study sought to evaluate the incidence of iatrogenic physeal bar formation following ACLR using high-resolution MRI and a validated bone age atlas. METHODS: A prospective series of patients undergoing transphyseal ACLR at a single institute, with high resolution 3T MRIs at 12 months, were included. MRI-validated knee bone age atlas was then used to exclude patients with evidence of physiological physeal closure. The remaining skeletally immature MRI scans were appraised by two independent reviewers for the presence of physeal bar formation adjacent to transphyseal ACL tunnels. RESULTS: From 142 patients undergoing transphyseal ACLR with post-operative MRI, 94 patients were found to exhibit evidence of complete closure of either the tibial or femoral physis and were excluded. 48 patients (38 male - mean age 14.1; 10 female - mean age 13.9) meeting inclusion criteria were included. Mean tibial tunnel diameter was 8.2 mm (SD ± 0.81) and mean femoral tunnel diameter was 7.9 mm (SD ± 0.88). There were two cases (4.2 % of total) of physeal bar formation in the proximal tibia in males (aged 14.2 and 14.7 years) with otherwise open physes. No leg length discrepancy was observed for these patients at a 12 months. No cases of femoral physeal bar formation were identified in our cohort. CONCLUSION: High resolution 3T MRI scan performed 12 months after transphyseal ACL reconstruction demonstrated 4.2 % incidence of tibial physeal bars and no femoral physeal bars. Neither of the cases physeal bar cases exhibited angular deformity or limb length discrepancy. Central physiological closure of the tibial physis was commonly seen in this age group and may be easily confused with physeal bar formation.
引言：经骨骺前交叉韧带重建术（ACLR）与肢体成角畸形和肢体长度差异风险相关，尤其是在剩余生长时间较长时。以往关于经骨骺ACLR影响的研究在估计骨龄时采用的方法不一致，因此可能低估了对骨骺的影响。本研究旨在使用高分辨率MRI和经过验证的骨龄图谱评估ACLR后医源性骨骺条形成的发生率。 方法：纳入在单一机构接受经骨骺ACLR的一系列前瞻性患者，这些患者在术后12个月进行了高分辨率3T MRI检查。然后使用MRI验证的膝关节骨龄图谱排除有生理性骨骺闭合证据的患者。其余骨骼未成熟的MRI扫描由两名独立的审阅者评估，以确定经骨骺ACLR隧道附近是否存在骨骺条形成。 结果：在142例行经骨骺ACLR并进行术后MRI检查的患者中，94例被发现有胫骨或股骨骨骺完全闭合的证据，予以排除。48例（38例男性，平均年龄14.1岁；10例女性，平均年龄13.9岁）符合纳入标准的患者被纳入。胫骨隧道平均直径为8.2mm（标准差±0.81），股骨隧道平均直径为7.9mm（标准差±0.88）。在骨骺仍开放的男性（年龄分别为14.2岁和14.7岁）中，有2例（占总数的4.2%）在胫骨近端出现骨骺条形成。这些患者在12个月时未观察到肢体长度差异。在我们的队列中未发现股骨骨骺条形成的病例。 结论：经骨骺ACLR术后12个月进行的高分辨率3T MRI扫描显示，胫骨骨骺条的发生率为4.2%，未发现股骨骨骺条。两例骨骺条病例均未出现角畸形或肢体长度差异。该年龄组常见胫骨骨骺中央生理性闭合，可能容易与骨骺条形成相混淆。
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