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The Effect of Placing a Tensioned Graft Across Open Growth Plates A Gross and Histologic Analysis
T. Bradley Edwards, MD; Craig C. Greene, MD; Richard V. Baratta, PhD; Arthur Zieske, MD; R. Baxter Willis, MD
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Investigation performed at the Bioengineering Laboratory, Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
T. Bradley Edwards, MD Craig C. Greene, MD Richard V. Baratta, PhD R. Baxter Willis, MD Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, 2025 Gravier Street, Suite 400, New Orleans, LA 70112. E-mail address for R.V. Baratta: rbarat@lsuhsc.edu
Arthur Zieske, MD Department of Pathology, Louisiana State University Health Sciences Center, 1901 Perdido Street, New Orleans, LA 70112
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Funds were received in total or partial support of the research or clinical study presented in this article. The funding source was the Orthopaedic Research and Education Foundation.

J Bone Joint Surg Am, 2001 May 01;83(5):725-734
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Abstract

Background: Midsubstance tears of the anterior cruciate ligament in skeletally immature patients are increasingly common and are a challenging problem. The results of nonoperative treatment are no better in children than they are in adults. Physeal-sparing reconstructive procedures have yielded poor results. Reconstructive procedures that are utilized in adults violate the physis, potentially resulting in growth abnormalities. The objective of this study was to provide a model for reconstruction of the anterior cruciate ligament in skeletally immature patients by evaluating the effects of a tensioned connective-tissue graft placed across the canine physis.

Methods: Twelve ten-week-old beagles underwent reconstruction of the anterior cruciate ligament consisting of placement of fascia lata autograft through drill-holes across the femoral and tibial physes, tensioning of the graft to 80 N, and fixing it with screws and washers. The contralateral limb served as a control. One dog was eliminated from the study secondary to a postoperative infection. Four months postoperatively, the dogs were killed and were inspected grossly, radiographically, and histologically for any evidence of growth disturbance.

Results: Significant valgus deformity of the distal part of the femur (p < 0.001) and significant varus deformity of the proximal part of the tibia (p = 0.03) developed in the treated limbs. Neither radiographic nor histologic examination demonstrated any evidence of physeal bar formation.

Conclusions: Significant growth disturbances occur with excessively tensioned transphyseal reconstruction of the anterior cruciate ligament in the canine model. These growth disturbances occur without radiographic or histologic evidence of physeal bar formation.

Clinical Relevance: This study illustrates the risk to the physis associated with transphyseal reconstruction of the anterior cruciate ligament with the use of a tensioned connective-tissue graft in skeletally immature patients. We do not recommend transphyseal reconstruction of the anterior cruciate ligament in this patient population.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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