title: The origin points of the knee collateral ligaments: an MRI study on paediatric patients during growth.
abstract: OBJECTIVE
  Different femoral origins for both the medial collateral ligament (MCL) and the lateral collateral ligament (LCL) have been reported in the growing skeleton (epiphyseal and metaphyseal). Knowledge about the exact attachment sites is mandatory for anatomically correct reconstruction. This study assesses the femoral origins of the knee collateral ligaments in skeletally immature individuals using magnetic resonance imaging (MRI).
  
  
  METHODS
  MRIs of 336 knee joints (median age 15 years (range 2-18 years), m = 209 and f = 127) were retrospectively analysed to assess the distances between the femoral origins of the MCL and LCL to the distal femoral growth plate. In 175 patients, the body sizes were additionally retrieved from medical records.
  
  
  RESULTS
  Both MCL and LCL ligament origins were invariably located on the epiphysis. Mean MCL origin-growth plate distance was 9.6 mm (SD 2.1 mm; range 2.2-13.6 mm) in boys and 8.6 mm (SD 1.5 mm; range 3.4-12.0 mm) in girls. Mean LCL origin-growth plate distance was 9.3 mm (SD 1.8 mm; range 4.3-13.0 mm) in boys and 8.2 mm (SD 1.5 mm; range 3.4-11.8 mm) in girls. The distance between the growth plate and both collateral ligaments as well as the length of the LCL correlated positively with patients' age and body size (MCL R(2) = 0.673 and 0.556, LCL R (2) = 0.734 and 0.645, LCL length R(2) = 0.589 and 0.741; all p < 0.001).
  
  
  CONCLUSIONS
  During growth, the femoral origins of the MCL and the LCL are constantly located on the distal femoral epiphysis. There is a linear increase in the distances from the ligaments' origins to the growth plate according to age and body size. This new information may be of clinical importance for reconstructive surgery of the knee's collateral ligaments.
authors.affiliation: Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria. sebastian.tschauner@medunigraz.at.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Tschauner
authors.affiliation: Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria.
authors.forename: Erich
authors.initials: E
authors.lastname: Sorantin
authors.affiliation: Department of Pediatric and Adolescence Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Singer
authors.affiliation: Department of Pediatric and Adolescence Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Robert
authors.initials: R
authors.lastname: Eberl
authors.affiliation: Department of Orthopedics and Orthopedic Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Annelie-Martina
authors.initials: AM
authors.lastname: Weinberg
authors.affiliation: MRT Institut Stolzalpe Dr. Schmidt, Stolzalpe, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Schmidt
authors.affiliation: Department of Pediatric and Adolescence Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Tanja
authors.initials: T
authors.lastname: Kraus
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017885:Collateral Ligaments / Q000033:anatomy & histology*; D004838:Epiphyses / Q000033:anatomy & histology; D005260:Female; D005269:Femur / Q000033:anatomy & histology* / Q000254:growth & development; D006132:Growth Plate / Q000033:anatomy & histology* / Q000254:growth & development; D006801:Humans; D007719:Knee Joint; D008279:Magnetic Resonance Imaging; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000033:anatomy & histology; D012189:Retrospective Studies
keywords: Children; Collateral ligaments; Growth; Knee; MRI; Origin
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