Intact PCL may predict ACL graft size for ACL reconstruction in pediatric patients
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Published results showed an intact PCL may be used to predict ACL graft size for ACL reconstruction in pediatric patients, while tunnel length differs based on the chosen drilling method in an all-epiphyseal technique.
“The intact PCL can be used as a patient-specific predictor of native ACL size. This, and other data presented, further illustrate the concept that care of the skeletally immature patients is not a ‘one-size-fits all’ scenario and each graft (or implant) must be carefully chosen,” Grant D. Hogue, MD, told Healio. “As orthopedic surgery continues to advance with machine learning and patient-specific treatments, we will see more investigations like this used to develop best implant and graft options for each individual.”
Hogue and colleagues made ACL and PCL coronal, sagittal and length measurements in 101 patients aged 5 to 18 years who had MRI of the knee at an outpatient orthopedic clinic from 2008 to 2020. Researchers also made tunnel length measurements in patients with open physes. Researchers performed statistical analyses to evaluate potential associations in patients’ bony or ligamentous measurements.
Results showed PCL sagittal width was a statistically significant predictor of ACL sagittal width and PCL coronal width was a statistically significant predictor of ACL coronal width. To calculate ACL coronal and sagittal width measurements from the corresponding measurement on an intact PCL, researchers developed two equations: ACL coronal width (mm) is equal to 6.23 plus (0.16 x PCL coronal width) and ACL sagittal width (mm) is equal to 5.85 plus (0.53 x PCL sagittal width). Researchers noted a positive correlation between age and the ratio of the size of the ACL to the size of the PCL in each plane.
Researchers found mean tibial maximum oblique length was longer than mean tibial physeal-sparing length. While mean femoral maximum oblique length was comparable to mean femoral physeal-sparing length, results showed both were longer than mean femoral straight lateral length.
Perspective
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Pediatric and adolescent ACL reconstruction is complicated by a high risk of graft rupture in this population. Appropriate graft diameter and anatomic femoral and tibial reconstruction points are two primary criteria to minimize ACL failure rates. The authors contribute additional data to assist the surgeon in planning for both graft size and tunnel location in the pediatric population. Their data correlates with previously published data on ACL size, and they demonstrate a stable ratio of ACL and PCL ligament diameter across ages and a resultant predictive formula for ACL diameter based upon the PCL measures. As previous literature on graft size has noted, the primary factor for surgical planning to avoid graft failure in this population is graft diameter greater than 8 mm; age-matched graft size resulting in a lesser diameter may not be a primary goal for the reconstructing surgeon. However, age-related data on ligament lengths and the measured tunnel lengths at different trajectories around the physis may assist the surgeon in planning for soft tissue graft length when preparing for appropriate reconstruction techniques while minimizing physeal risk in this population.
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