Transepiphyseal Replacement of the Anterior Cruciate Ligament in Skeletally Immature Patients. A Preliminary Report

Abstract

To The Editor: We read the article, “Transepiphyseal Replacement of the Anterior Cruciate Ligament in Skeletally Immature Patients. A Preliminary Report” (2003;85:1255-63), by A.F. Anderson. Clearly, the author is attempting to address a difficult problem in relation to the anterior cruciate-deficient knee in early adolescence. The mean age in his series was 13.3 ± 1.4 years, which is three to four years prior to epiphyseal closure in the femur and tibia in boys. By the same token, the epiphysis also has the potential for growth during this period, and therefore, with time, the consequences for the graft will be either stretching or, if stretching is not encountered, gradual tunnel enlargement, particularly on the femoral side. Also, the need to avoid violation of the physis will make tunnel placement that avoids impingement on the tibial side and anatomic siting on the femoral side extremely difficult to perform and certainly, on the femoral side, it is unlikely that the tunnel siting will be reproducible. We noted with particular interest that the guide wire placement illustrated by a lateral view of the tibia (Fig. 2) in the article is only 25% of the anteroposterior diameter of the tibial plateau and therefore would be highly likely to produce an anterior tunnel placement, which would subsequently produce graft impingement. The opinion that isometric ligament placement either can be achieved or indeed is desirable is open to question, and, given that the over-the-top route has … Corresponding author: Christos K. Yiannakopoulos, MD Byzantiou 2 171 21 Nea Smyrni Athens Greece cky{at}ath.forthnet.gr