Tibialis Allograft for Open Physis 15Y/O

[randyinelkgrove]

I've been searching and looking and getting beat up by other boards members. Our OS has recommended a Tibialis allograft for my son. I figure it to be the less taken away from his own body the better. I was set to hear hammy when we first went there with my own research.
Soft tissue to pass through the physis. He does not recommend anything with Bone attached for physeal closure reasons. I was all happy until I asked another board about it and got blasted for being a bad parent for considering it. My OS is well respected, a proffesional team OS, a teaching OS at a Medical school, so I was all set to go with him on his recomendation. Well now I wonder. My son is big for his age, 6' 3", 185lbs a four sport athlete Baseball, track, Football and Basketball. Injured his knee in football last season. Any ideas?

[ATsoccergirl]

Hey Randy,

That other board can be brutal, most of the people on there are just voicing their own opinion based on their experiances.  There are a few professionals on there (myself included). 

I would highly recommend the course of action your surgeon suggested.  It is consistant with all the research I have ever seen on performing ACL reconstructions on skeletally immature athletes.  I am not a big fan of using the hamstring autograft on anyone, the hamstrings can control the knee better than the ACL itself.  Most non-operative ACL protocols focus on extensive hamstring strengthening and neuromuscular control. 

I'm assuming your son has had x-rays which show that his growth plates are still open.  But I would recommend finding out about how long he has until they close.  If it is less than six months, I would suggest waiting until they are closed and then proceeding with the ACLR as if he were an adult.  Athletes with open growth plates who undergo ACLR do tend to have higher failure rate since in order to avoid the growth plates the graft is placed slightly different. 

[hottubpam]

If it were my son, I'd get at least a second opinion and maybe a third, especially since the procedure your OS is recommending is somewhat controversial.  If you are in Elk Grove, Calif. I highly recommend a trip to the Palo Alto Medical Foundation, across from The Farm.  The Sports Medicine OS's there are outstanding.

Good Luck,
Pam

[ATsoccergirl]

Randy,

I found this article today:

 J Knee Surg. 2002 Spring;15(2):72-6. Related Articles, Links 


MRI evaluation of growth plate closure rate and pattern in the normal knee joint.

Sasaki T, Ishibashi Y, Okamura Y, Toh S, Sasaki T.

Department of Orthopedic Surgery, Hirosaki University School of Medicine, Japan.

The records of 320 patients (145 boys and 175 girls) who underwent magnetic resonance imaging (MRI) for the diagnosis of meniscal injury were reviewed. Growth plates of the distal femur and proximal tibia were examined, and the closure rate of the growth plates in each age group was evaluated. Imaging of the growth plates was low-signal intensity on T1-weighted MRI, high-signal intensity on T2-weighted MRI, and high-signal intensity on T2-gradient-recalled echo MRI. The disappearance rates of high-signal band on T2-gradient-recalled echo MRI in each age group were: 0% at < or = 11 years, 5% at 12 years, 34% at 13 years, 53% at 14 years, 94% at 15 years, and 100% at > or = 16 years. In the tibial growth plate on coronal MRI, the central portion had a tendency to close earlier than the peripheral portion. The results of this study suggest T2-gradient-recalled echo MRI should be used for diagnosis and follow-up of the growth plate. Furthermore, the fact that growth plate closure starts centrally suggests the possibility of using a tibial tunnel for anterior cruciate ligament reconstruction in young patients.


Other articles that may interest you:

http://www.medscape.com/viewarticle/460921
http://www.medscape.com/medline/abstract/10688283
http://www.medscape.com/medline/abstract/12368777
http://www.medscape.com/medline/abstract/14673466