POSTER ABSTRACTS - ISAKOS

quadrant and the posterolateral bundle in zone 7
(18 out of 22). Using the posterior condyle
reference method, the centre of the anteromedial
bundle was at 68.0% (SD 6.5%, range 57 - 78%) in a
shallow-deep direction and 54.6% (SD 5.2%, range
44 - 62%) in a high-low direction. The
posterolateral bundle was found at a distance of
56.3% (SD 8.4%, range 40 - 73%) in a shallow-deep
direction, and 62.4% (SD 7.0%, range 40 - 70%) in a
high-low direction.
E-poster #410
Topographical Anatomy in Anterior Cruciate
Ligament Replacement Surgery in Children
Romain Seil, Luxembourg, LUXEMBOURG,
Presenter
Stefan Milz, Munich, GERMANY
Alexander Gohm, Feldkirch, AUSTRIA
Dept. of Orthop.Surgery, Univ. of Saarland,
Homburg / Saar, GERMANY
Introduction:
Anterior cruciate ligament replacement surgery in
children is controversial. Many treatment options,
including a high number of operative techniques,
have been described. Among pediatric
orthopaedic surgeons, the periphery of the growth
plate is a structure at risk for secondary growth
changes. The purpose of the present anatomical
cadaver study was to analyze the relation between
routinely used tibial and femoral tunnels of an
intraarticular, transphyseal ACL replacement
technique, the tibial and femoral growth plate and
relevant soft-tissue structures around the knee.
Material and Methods:
2 cadaveric knee specimens of a 10-year old child
were used. After removal of the skin and the
subcutaneous tissue a 6 mm tibial and femoral
tunnel was drilled. Tunnel placement was
comparable to routine ACL reconstruction
techniques in adults (40-50 angulation to the
longitudinal axis of the tibia and femur; use of
tibial and femoral drill guides). After drilling of the
tunnels, the distance between both tunnel
entrances on the tibia and the femur and relevant
anatomical structures (growth plates, ossification
groove of Ranvier, fibrous ring of LaCroix, tendon
insertion areas) was measured. Finally a sagittal
section was performed through the tunnels and
the relation between the tunnel and the growth
plate was analyzed.
Results:
Tibia: The tunnel entrance on the anteromedial
side of the tibia was located in small area of 2 x 2
cm delimited by the tibial tuberosity apophysis on
the lateral side, the superior border of the pes
anserinus on the infero-medial side and the
periphery of the proximal tibial growth plate
cranially. The lesion created by the tibial tunnel
was located within the centre of the growth plate.
The angle between the growth plate and the
tunnel axis was 85 (+/- 5 ), creating a round drill
injury.
Femur: The distance between the femoral tunnel
entrance (corresponding to the femoral origin of
the ACL) and the periphery of the postero-lateral
growth plate was 3.5 mm in average. The lesion of
the growth plate created by the femoral tunnel
was excentrically located. At the height of the
growth plate the distance of the posterior tunnel
wall and the periphery of the growth plate
(ossification groove and fibrous ring) was 2.5 (+/-
0.5) mm. Due to the inclination of the drill guide
the angle between the growth plate and the
longitudinal axis of the femoral tunnel was 30 (+/-
5 ). This increased the surface of the drill hole
from 28.2 to 56.5 mm² (100 %)
Conclusion:
A too cranial tibial tunnel entrance (injury of the
periphery of the tibial growth plate) or a too
lateral placement (tibial tuberosity apophysis)
might have a potential of secondary growth
changes after ACL replacement on the tibial side.
On the femoral side a too posterior tunnel
placement might cause an injury of the periphery
of the growth plate. The femoral drill injury is
larger than the tibial drill injury. Since drilling of
the femoral tunnel is more difficult to control
during surgery, the femur might be at a higher risk
for secondary growth changes after ACL
replacement procedures in children. Surgeons
performing ACL replacements in children should
be aware of the specific pediatric anatomy.
E-poster #411
Proprioception Differences in Elite Female
Athletes - Implication for ACL Injury Protection
Henry Thomas Goitz, Toledo, OH, USA, Presenter
Rebecca LynnMocniak, Toledo, Ohio USA
Jennifer Metz, Cincinnati, Ohio USA
Lynsey Ebel, Toledo, Ohio USA
Pam Place, Toledo, Ohio USA
The University of Toledo, Toledo, OH, USA
INTRODUCTION: Professional ballet dancers
utilize the extremes of flexibility, coordination,
postural control, and balance, giving them a
proposed greater proprioception ability than their