This 1995 canine cadaver study tested whether a soft tissue graft placed through trans-physeal drill holes could prevent bony bridge formation across open growth plates. It is the foundational basic science paper supporting trans-physeal ACL reconstruction in skeletally immature patients.
The fear of trans-physeal drilling in children was rooted in animal data showing that empty drill holes reliably cause physeal fusion. What was unknown before this paper was whether filling those holes with soft tissue could interrupt that process.
This study established the basic science rationale for trans-physeal ACL reconstruction in skeletally immature patients: when you place a soft tissue graft that completely fills the physeal tunnel, bony bridge formation is prevented. The key word is completely — partial filling is not sufficient, and a bone block (as in bone-patellar tendon-bone) must not cross the growth plate.
In clinical practice, this means all-soft-tissue trans-physeal reconstruction (hamstring autograft or soft tissue allograft) is the preferred technique when operating on a patient with significant growth remaining. The graft itself acts as the protective barrier.
Remember: absence of leg length discrepancy does not rule out physeal damage, either in this model or in your pediatric patients. Radiographic and histologic evaluation of the physis is the appropriate assessment.
This 1995 canine cadaver study tested whether a soft tissue graft placed through trans-physeal drill holes could prevent bony bridge formation across open growth plates. It is the foundational basic science paper supporting trans-physeal ACL reconstruction in skeletally immature patients.
The fear of trans-physeal drilling in children was rooted in animal data showing that empty drill holes reliably cause physeal fusion. What was unknown before this paper was whether filling those holes with soft tissue could interrupt that process.
This study established the basic science rationale for trans-physeal ACL reconstruction in skeletally immature patients: when you place a soft tissue graft that completely fills the physeal tunnel, bony bridge formation is prevented. The key word is completely — partial filling is not sufficient, and a bone block (as in bone-patellar tendon-bone) must not cross the growth plate.
In clinical practice, this means all-soft-tissue trans-physeal reconstruction (hamstring autograft or soft tissue allograft) is the preferred technique when operating on a patient with significant growth remaining. The graft itself acts as the protective barrier.
Remember: absence of leg length discrepancy does not rule out physeal damage, either in this model or in your pediatric patients. Radiographic and histologic evaluation of the physis is the appropriate assessment.