Volumetric Damage to the Femoral Physis During Double-Bundle Posterior Cruciate Ligament Reconstruction: A Magnetic Resonance Imaging Computer Modeling Study

Midterm Clinical Results After All-Epiphyseal Double-Bundle Reconstruction of the Anterior Cruciate Ligament in Children With Open Physes

“…24 In comparison with single-bundle reconstruction, doublebundle reconstruction with the transphyseal technique carries a higher risk for iatrogenic physeal injury in children with open physes. 23 We therefore created all 4 bone tunnels in an all-epiphyseal manner, despite the technical difficulties of this technique. There have been few clinical reports of double-bundle ACLR with transepiphyseal technique 24 or partial physealsparing techniques, as opposed to a complete physealsparing technique, in skeletally immature patients.…”

It is feasible to perform an all-epiphyseal double-bundle posterior cruciate ligament reconstruction in skeletally immature patients? A computer-aided modelling study

“…Recent case series have reported this injury in young patients,4 and surgical reconstruction has shown successful outcomes in these small series. Physeal-violating DB reconstructions carry the inherent risk of growth abnormalities and physeal arrest,1 and recent anatomic research using cadaveric specimens has shown that using an inside-out technique can affect up to 4% of the physis 11. Although the PM avoids disrupting the physis, the AL tunnel may transverse the physis and can result in a small volume of damage to the peripheral physis.…”

“…Non-operative measures may fail and result in recurrent instability. Surgical reconstruction—especially using double-bundle (DB) techniques—has the risk of causing damage to the physeal and periphyseal regions of the femur,11 which may lead to significant growth disturbance 12–16. Injury to other structures may also occur with PCL reconstruction, including the articular cartilage, and the origins of the medial patellofemoral ligament (MPFL) and medial collateral ligament (MCL).…”

“…As both single-bundle and DB techniques are performed, it is important to evaluate the feasibility and potential complications of DB PCL reconstruction in the skeletally immature knee. Physeal damage using a transphyseal DB PCL reconstruction technique can result in up to 4% physeal volume damage 11. While one study suggests this volume of damage is thought to carry a relatively low risk of growth arrest,16 violation and placement of graft across even 1% of the physis may put patients at risk of secondary growth disturbance 21.…”

Avoiding tibia physeal injury during double-bundle posterior cruciate ligament reconstruction

“…An increase in paediatric PCL and/or combined PCL and posterolateral corner injuries may necessitate development of physeal-sparing PCL reconstruction techniques. The effect of single-bundle and double-bundle PCL reconstructions on the femoral physis has been investigated,28 but little is known about the effect of PCL reconstruction on physeal growth. Anderson et al 3 successfully used an all-metaphyseal, physeal-sparing tibial tunnel above the physis, and Bovid et al 4 successfully used a modified tibial inlay technique via an epiphysial retro-drill technique with minimal damage to the physis.…”