Transphyseal anterior cruciate ligament reconstruction in skeletally immature patients: Quantification of physeal damage using a three-dimensional simulation model study

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dc.catalogadordfo
dc.contributor.authorFernandéz Comparini, Tomás Alberto
dc.contributor.authorTuca, María
dc.contributor.authorFernandez Schlein, Francisco Andrés
dc.contributor.authorBesa Vial, Pablo José
dc.contributor.authorLira Salas, María Jesus
dc.contributor.authorVidal, Catalina
dc.contributor.authorIrarrázaval, Sebastián
dc.date.accessioned2025-11-03T18:08:09Z
dc.date.available2025-11-03T18:08:09Z
dc.date.issued2025
dc.description.abstractPurpose This study investigated how tunnel orientation and diameter affect physeal damage during transphyseal anatomic anterior cruciate ligament (ACL) reconstruction. The focus was on the distal femoral physis (DFP) and proximal tibial physis (PTP) using a three-dimensional (3D) model derived from magnetic resonance imaging (MRI) of skeletally immature patients. Methods MRI scans from patients aged 10–17 years were segmented to create 3D models of the distal femur, proximal tibia, and their respective physes. Simulations of full-length ACL tunnels were performed using 7-, 8-, 9-, and 10-mm drills, starting at the ACL footprint and covering all possible angulations. Physeal damage was quantified as a percentage of total growth plate volume and analyzed according to tunnel diameter, orientation, patient age, and sex. Statistical analyses were applied, with significance set at P < 0.05. Results Maximum DFP damage (14.6 % ± 3.9) occurred with horizontal tunnels and 10-mm drill diameter, with significantly greater damage in males. Less than 7 % DFP damage was observed when using vertical tunnels (>45° cephalic) and anteromedial (AM) portal direction. For the PTP, the highest damage occurred with oblique angles and 10-mm drills (5.5 % ± 2.4), with statistically significant variation by tunnel size and patient age, but not by sex. Conclusions Tunnel orientation and diameter significantly influence physeal damage during pediatric ACL reconstruction. Vertical tunnels and anteromedial drilling directions minimize growth plate injury, supporting their use in surgical planning to reduce the risk of long-term growth disturbances.
dc.fuente.origenORCID
dc.identifier.doi10.1016/j.knee.2025.09.008
dc.identifier.issn0968-0160
dc.identifier.urihttps://doi.org/10.1016/j.knee.2025.09.008
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/106495
dc.information.autorucEscuela de Medicina; Irarrazaval Dominguez, Sebastian; 0000-0002-1215-1709; 12853
dc.information.autorucEscuela de Medicina; Fernandez Comparini Tomas Alberto; S/I; 223277
dc.information.autorucEscuela de Medicina; Fernandez Schlein Francisco Andres; S/I; 222305
dc.information.autorucEscuela de Medicina; Besa Vial Pablo Jose; 0000-0001-6690-1678; 162788
dc.information.autorucEscuela de Medicina; Lira Salas Maria Jesus; 0000-0001-8512-1052; 195663
dc.language.isoen
dc.nota.accesoContenido parcial
dc.revistaThe Knee
dc.rightsAcceso restringido
dc.subjectAnterior cruciate ligament reconstruction
dc.subjectSkeletally immature patients
dc.subjectGrowth plate
dc.subjectPhyseal damage
dc.subjectMRI 3D simulation model
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.titleTransphyseal anterior cruciate ligament reconstruction in skeletally immature patients: Quantification of physeal damage using a three-dimensional simulation model study
dc.typeartículo
sipa.codpersvinculados12853
sipa.codpersvinculados223277
sipa.codpersvinculados222305
sipa.codpersvinculados162788
sipa.codpersvinculados195663
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