ABSTRACT
PURPOSE: To quantify and compare the amount and location of physis violation of the distal femur and proximal tibia after transphyseal anterior cruciate ligament (ACL) reconstruction in skeletally immature patients. METHODS: This study included 19 patients with open physes of the distal femur and proximal tibia who underwent ACL reconstruction with tibialis anterior allografts. Physeal tunnel volume and location on the growth plate, as well as obliquity to the growth plate, were measured by 3-dimensional postoperative magnetic resonance imaging of the distal femur and proximal tibia. RESULTS: The percentage of physeal violation (ratio of the tunnel to the entire growth plate area) was similar for the distal femur and proximal tibia (3.95% vs 3.65%, P = .582). There were no differences in tunnel obliquity to the growth plate in the coronal (56.1° vs 71.6°, P = .061) and sagittal (85.9° vs 74.9°, P = .092) planes. The distal femoral tunnel was located 6.2% (17.2% vs 23.4%, P = .001) more peripherally in the anteroposterior direction and 9.7% (27.1% vs 36.8%, P < .001) more peripherally in the mediolateral direction than was the tibial tunnel. CONCLUSIONS: The mean percentages of physeal violation of tunnel creation during ACL reconstruction in adolescent patients were 3.95% for the distal femur and 3.65% for the proximal tibia. Moreover, femoral tunnels were located more peripherally on the growth plate than were tibial tunnels, in both the anteroposterior and mediolateral directions. LEVEL OF EVIDENCE: Level IV, case series.
Subject(s)
Anterior Cruciate Ligament Injuries/surgery , Adolescent , Anterior Cruciate Ligament Injuries/diagnostic imaging , Anterior Cruciate Ligament Reconstruction/methods , Child , Epiphyses/diagnostic imaging , Epiphyses/surgery , Female , Femur/diagnostic imaging , Femur/surgery , Growth Plate/diagnostic imaging , Growth Plate/surgery , Humans , Imaging, Three-Dimensional , Magnetic Resonance Imaging/methods , Male , Postoperative Period , Tibia/diagnostic imaging , Tibia/surgeryABSTRACT
BACKGROUND: Although some studies have evaluated the clinical impact of lumbosacral transitional vertebrae (LSTV), few have attempted to determine an effective conservative treatment method for lumbar disc herniation (LDH) presenting concurrently with LSTV. METHODS: We prospectively enrolled 291 consecutive patients who were followed-up for at least one year after transforaminal epidural injection (TFEI) for LDH. We confirmed the presence of LSTV with Paik et al.'s method, the Castellvi classification, and the Southworth and Bersack method. Clinical outcomes were evaluated with a visual analogue scale (VAS) for pain intensity and the Oswestry Disability Index (ODI) for functional status. RESULTS: Of the 291 patients, 47 (16.2%) had LSTV, including 33 with sacralization and 14 with lumbarization, while 244 (83.8%) did not have LSTV. Patients in both groups improved significantly after TFEI in terms of the VAS (P < 0.001) and ODI (P < 0.001) scores. However, LDH patients with LSTV had a worse clinical outcome after six months of TFEI than did those without LSTV, with a significant difference between groups for both the VAS (P < 0.01) and ODI (P = 0.01) scores. LDH patients with sacralization had worse post-treatment clinical outcomes than LDH patients with lumbarization (P < 0.001) or LDH patients without LSTV (P < 0.001). CONCLUSIONS: Sacralization can reduce the improvement after TFEI among LDH patients, while lumbarization appears to have no direct effect on TFEI outcomes. The presence of sacralization should be identified before TFEI, and if present, patients should be informed that the outcomes of TFEI may not be as good as they would be if sacralization was not present.
