THE DISTANCE BETWEEN TIBIAL PHYSIS AND CORONARY LIGAMENT: A PEDIATRIC CADAVERIC STUDY

Aleksei Dingel; Alexander Karius; Laura C. Boucher; Yi-Meng Yen; Theodore J. Ganley; Philip L. Wilson; Henry B. Ellis; Peter D. Fabricant; Marc Tompkins; Kevin Shea

摘要

Background: Meniscal injuries in the skeletally immature have been increasingly reported. Many meniscal repair surgeries involve the approximation of the meniscus tissue to the peripheral meniscus capsule. This peripheral fixation may not be ideal for some meniscus tear patterns, and may contribute to ‘peripheralization’ of the meniscus during the healing process, which may alter the weight bearing distribution function of the meniscus/articular cartilage complex. Surgical procedures that do not periperalize the meniscus are being developed, which may better replicate the normal meniscus anatomy. Purpose: The primary purpose of this study was to evaluate the coronary ligament attachments of the meniscus, and how this may influence further development of anatomic repair techniques and implants to address meniscus injury. The secondary purpose of this study was to determine the distance between the tibial insertion of the coronary ligament and the proximal tibial physis. Methods: 10 skeletally immature knee cadaver specimens between the ages of 3 months and 11 years (3 female, 7 male) were included in this study. Prior to CT, pins were placed in the tibias marking the coronary ligament insertion at designated points surrounding both the medial and lateral menisci (Figure 1). Using OsiriX, a medical imaging software, the distances between the proximal tibial physis and the coronary ligament insertion sites were measured at 10 points (5 lateral: anterior root, 12 o’clock, 3/9 o’clock, 6 o’clock, and posterior root, and 5 medial: anterior root, 12 o’clock, 3/9 o’clock, 6 o’clock, and posterior root). Axial view was used confirm proper pin measurement and the measurements were gathered in either the sagittal and coronal view depending on the pin’s placement. The specimen were divided into two groups for analysis- Group 1: ages 3 months- 2 years, Group 2: ages 10-11 years. Results: Medial Meniscus The average distance from the proximal tibial physis to the posterior medial root of the coronary ligament was 0.48 ± 0.08 cm and 1.02 ± 0.10 cm for Group 1 and Group 2, respectively. The average distance from the physis and the 6 o’clock pin was 0.37 ± 0.19 cm and 0.78 ± 0.23 cm. The average distance from the physis and the 3/9 o’clock pin was 0.32 ± 0.13 cm and 0.73 ± 0.22 cm. The average distance from the physis to the 12 o’clock pin was 0.14 ± 0.22 cm and 0.65 ± 0.45 cm. The average distance from the physis to the anterior pin was 0.21 ± 0.30 cm and 1.01 ± 0.62 cm. Lateral Meniscus The average distance from the proximal tibial physis to the posterior lateral root of the coronary ligament was 0.48 ± 0.11 cm and 1.62 ± 0.29 cm for Group 1 and Group 2, respectively. The average distance from the physis and the 6 o’clock pin was 0.38 ± 0.16 cm and 1.72 ± 0.25 cm. The average distance from the physis and the 3/9 o’clock pin was 0.17 ± 0.15 cm and 0.1.41 ± 0.19 cm. The average distance from the physis to the 12 o’clock pin was -0.04 ± 0.20 cm and 0.60 ± 0.14 cm. The average distance from the physis to the anterior pin was 0.16 ± 0.07 cm and 0.31 ± 0.16 cm. Conclusions: Our results show an increase in the distance between the proximal tibial physis and the insertion points of the coronary ligament as age increases. For all measurements, medial and lateral, Group 1 (the younger specimen’s) tibial insertion of the coronary ligament was less than 1 cm away from the physis. Group 2’s coronary ligament insertion points were further away from the physeal line, however still less than 2 cm away, and sometimes even as close as &0.5 cm (anterolateral root). As this data shows the close proximity of the physis and coronary ligament attachements on the meniscus, they confirm the need for the development of anatomic repair techniques and implants that are mindful of the growth plate and avoid physeal injury. Clinical Significance: This study of pediatric cadaveric specimens allowed for direct visualization of the coronary ligament anatomy on the tibia. This information is clinically significant as it detailed the developmental pattern of coronary ligament anatomy in pediatrics and can be used by surgeons performing meniscal injury reconstructions and repairs in patients with open physes. Figure 1. Medial (blue) and lateral (red) meniscal pin placement.

机译：背景：关于骨骼未成熟的半月板损伤的报道越来越多。许多半月板修复手术涉及将半月板组织近似于外周半月板囊。这种外围固定对于某些半月板撕裂模式可能不是理想的，并且可能在愈合过程中导致半月板“周围化”，这可能会改变半月板/关节软骨复合体的承重分布功能。正在开发不会在半月板周围穿刺的手术程序，这可能会更好地复制正常的半月板解剖结构。目的：本研究的主要目的是评估半月板的冠状韧带附着物，以及它如何影响解剖修复技术和植入物以解决半月板损伤的进一步发展。这项研究的次要目的是确定胫骨冠状韧带插入与胫骨近端之间的距离。方法：本研究包括10例3个月至11岁之间的骨骼不成熟的膝盖尸体标本（3例女性，7例男性）。 CT之前，将销钉放置在胫骨中，在围绕内侧和外侧半月板的指定点标记冠状韧带的插入（图1）。使用医学成像软件OsiriX，在10个点（5个侧面：前根，12点，3/9点，6点，和后根，以及5个内侧：前根，12点，3/9点，6点和后根）。使用轴向视图确认正确的插针测量，并且根据插针的位置以矢状和冠状视图收集测量值。将标本分为两组进行分析-组1：年龄3个月至2岁，组2：年龄10-11岁。结果：内侧半月板对于第一组和第二组，胫骨近端到冠状韧带后内侧根的平均距离分别为0.48±0.08 cm和1.02±0.10 cm。身体与6点钟针的平均距离为0.37±0.19厘米和0.78±0.23厘米。距身体和3/9点钟针的平均距离为0.32±0.13 cm和0.73±0.22 cm。从身体到12点钟的平均距离为0.14±0.22 cm和0.65±0.45 cm。从关节到前针的平均距离为0.21±0.30 cm和1.01±0.62 cm。外侧半月板对于第一组和第二组，从胫骨近端到冠状韧带的后外侧根的平均距离分别为0.48±0.11 cm和1.62±0.29 cm。身体与6点钟针的平均距离为0.38±0.16厘米和1.72±0.25厘米。距骨和3/9点钟的平均距离为0.17±0.15厘米和0.1.41±0.19厘米。从物理位置到12点钟的平均距离为-0.04±0.20 cm和0.60±0.14 cm。从关节到前针的平均距离为0.16±0.07 cm和0.31±0.16 cm。结论：我们的结果表明，随着年龄的增长，胫骨近端物理距离与冠状动脉韧带插入点之间的距离增加。对于所有测量，内侧和外侧，第1组（较年轻的标本）胫骨胫骨韧带的插入距离实体均小于1 cm。第2组的冠状韧带插入点距离骨干线较远，但仍小于2 cm，有时甚至小于＆ 0.5 cm（前外侧根）。由于该数据表明半月板上的生理器官和冠状韧带附着物非常接近，因此他们确认了对发展解剖修复技术和植入物的需求，这些技术和植入物应注意生长板并避免骨赘损伤。临床意义：这项对儿童尸体标本的研究可以直接可视化胫骨上的冠状韧带解剖结构。该信息详细描述了儿科患者冠状韧带解剖结构的发展模式，具有临床意义，可供外科医生在开放性植骨患者中进行半月板损伤重建和修复时使用。图1.内侧（蓝色）和外侧（红色）半月板针的位置。

THE DISTANCE BETWEEN TIBIAL PHYSIS AND CORONARY LIGAMENT: A PEDIATRIC CADAVERIC STUDY

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