3D MRI Helps Young Athletes with ACL Tears Return to Sports

New technology has made it possible for surgeons to reconstruct anatomic anterior cruciate ligament (ACL) tears in young athletes without disturbing the growth plate.

John Xerogeanes, MD, chief of the Emory Sports Medicine Center, and colleagues in the laboratory of Allen R. Tannenbaum, PhD, professor in the Wallace H. Coulter department of biomedical engineering at Georgia Institute of Technology (Atlanta, GA, USA) and Emory University (Atlanta, GA, USA), have developed three-dimensional (3D) magnetic resonance imaging (MRI) technology that allows surgeons to preoperatively plan and perform anatomic ACL surgery.

ACL tears are one of the most common injuries in children who participate in sports including football, basketball, soccer, and gymnastics. Conventional treatment for ACL injuries in children has been rehabilitation, wearing a brace, and staying out of athletics until the child stops growing--typically in the mid-teens--and ACL reconstruction surgery could then safely be performed. "The problem with doing surgery on a young child is that if you damage the growth plate, you can cause a growth disturbance,” said Dr. Xerogeanes, an associate professor in the department of orthopedics at Emory University School of Medicine.

The ACL is one of the four major ligaments in the knee, similar to a rubber band, attached at two points to keep the knee stable. To replace the ligament, surgeons create a tunnel in the upper and lower knee bones, slide the new ACL between those two tunnels, and attach it at both ends. (The new ligament is typically taken from either a hamstring tendon or an allograft tissue, which is donor material.)

Dr. Xerogeanes explained that prior to using the 3D MRI scanning, ACL operations were performed with extensive use of X-rays in the operating room, and left too much to chance when working around growth plates. With this new technology, surgeons can actually see from one point to the other on either side of the knee, and can accurately position the tunnels where they will place the new ligament. The surgery can be done in less time than the traditional surgery, and with confidence that the growth plates in young patients will not be damaged.

Children who undergo this type of operation will still have at least one year of recovery time, advised Dr. Xerogeanes. The upside is that it does allow them to pursue normal activity eventually.

Dr. Xerogeanes and his colleagues at Emory are performing the anatomic ACL reconstruction technique on adult patients as well as pediatric patients. He hopes that another advantage of this new anatomic procedure will be that it helps prevent re-injury in the future for all athletes who have suffered from ACL tears.

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