Understanding the undulating pattern of the distal femoral growth plate: Implications for surgical procedures involving the pediatric knee: A descriptive MRI study

Abstract

IntroductionOperative procedures near the distal femoral physis can result in iatrogenic damage if one is not familiar with the complex anatomy of the growth plate. The purpose of this study was to use physeal-specific MRI sequences to delineate the anatomic dimensions of the distal femoral physis. Materials and methodsSixty patients underwent physeal-specific spoiled gradient 3-D fat saturated (SPGR) MRI analysis of a single knee. Three age groups (eight to 10, 11–13, and 14–16 years) comprised of equal numbers (n = 20) of boys and girls were evaluated. Using the SPGR coronal sequence, the distance of the physis to the femoral articular cartilage was recorded at the medial, mid-medial, notch, mid-lateral and lateral margins of the knee. Coronal measurements were recorded at four locations along the sagittal sequence, as the anteroposterior dimension of the knee was divided into equal quartiles. ResultsWhile little variation in shape was observed in the anterior quartile, the remaining quartiles demonstrated significant variability that increased moving posteriorly (p < .001), therefore reflecting a more concave shape in the posterior aspect of the femur. These observations were statistically significant for age at the posterior two quartiles. ConclusionThese MRI data suggest that while the physis is linear in the anterior part of the femur, it possesses a more concave shape in the posterior aspect of the medial and lateral condyles. Findings were preserved across gender and age. Ultimately, these data can aid in preoperative planning and should be considered when performing operative procedures in the skeletally immature knee.