title: Hindlimb growth after a transphyseal reconstruction of the anterior cruciate ligament: a study in skeletally immature sheep with wide-open physes.
abstract: BACKGROUND
  There is a lot of controversy in the recent literature with regard to the optimal treatment of anterior cruciate ligament (ACL) injuries during growth. Iatrogenic growth disturbance due to physeal damage is a potential complication, forcing many orthopaedic surgeons to treat these injuries conservatively.
  
  
  OBJECTIVE
  It is possible to perform a fully transphyseal ACL reconstruction in an ovine model with wide-open physes without creating growth disturbances.
  
  
  METHODS
  Descriptive laboratory study.
  
  
  METHODS
  Four-month-old skeletally immature sheep underwent a transphyseal ACL reconstruction of the right knee. The surgical technique followed the criteria known to be essential to avoid growth disturbances in humans; the tibial tuberosity was spared to prevent a genu recurvatum, thermal damage to the growth plates was avoided, the physes were perforated with a small-diameter drill in the center of the growth plate, a soft tissue graft was used, graft fixation was achieved far away from the growth plates, the perforated growth plates were filled by the soft tissue graft, and the graft was moderately pretensioned before fixation. The left knee served as a control. A computer-assisted evaluation of long radiographs (frontal and sagittal plane) of the exarticulated hindlimbs was performed to exactly evaluate the limb alignment, joint orientation, and leg length. The animals were sacrificed in groups of 6 after 3, 6, 12, and 24 weeks.
  
  
  RESULTS
  No angular deformities or leg-length discrepancies occurred after this transphyseal ACL reconstruction procedure throughout the remaining growth.
  
  
  CONCLUSIONS
  This large-animal study supports the clinical observation that it is possible to perform an ACL reconstruction without creating growth disturbances as long as a number of key principles are followed.
  
  
  CONCLUSIONS
  Previous animal studies argued against ACL reconstruction in skeletally immature patients. This large-animal study provides support for early operative treatment of ACL ruptures even in young patients with open physes.
authors.affiliation: Trauma Department, Hannover Medical School, Hannover, Germany. meller.rupert@mh-hannover.de
authors.forename: Rupert
authors.initials: R
authors.lastname: Meller
authors.forename: Daniel
authors.initials: D
authors.lastname: Kendoff
authors.forename: Stefan
authors.initials: S
authors.lastname: Hankemeier
authors.forename: Michael
authors.initials: M
authors.lastname: Jagodzinski
authors.forename: Martin
authors.initials: M
authors.lastname: Grotz
authors.forename: Karsten
authors.initials: K
authors.lastname: Knobloch
authors.forename: Christian
authors.initials: C
authors.lastname: Krettek
mesh_terms: D000818:Animals; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D001178:Arthroplasty / Q000379:methods; D001846:Bone Development; D005260:Female; D006614:Hindlimb / Q000254:growth & development / Q000601:surgery*; D012756:Sheep; D013977:Tibia / Q000601:surgery