Conclusiones: Reconstrucción de Ligamento

Este estudio nos permite concluir que a las 12 semanas existen alteraciones histológicas significativas en la fisis tibial proximal de los caninos, luego de la reconstrucción del LCA tanto con túneles transfisiarios como con la técnica “sobre el cóndilo”. Es evidente la alteración en el tamaño, la variación en el cierre fisiario, la alteración en el patrón celular de la fisis y la formación de puentes óseos a través de los túneles transfisiarios.

A pesar de no encontrar diferencias de longitud estadísticamente significativas a la 12a semana, es posible que éstas sean evidentes al final del crecimiento. El hecho de tener a la 12a semana una fisis muy próxima a cerrarse, nos sugiere que la magnitud de cambios histológicos producidos en las fisis con las dos técnicas de reconstrucción del LCA utilizadas, no tienen una representación clínica importante en la longitud de la extremidad. Sin embargo, son necesarios estudios con mayor seguimiento, al igual que la comparación de las alteraciones histológicas con posibles deformidades angulares, para establecer las repercusiones clínicas de la reconstrucción del LCA en esqueleto inmaduro, con túneles transfisiarios o con la técnica “sobre el cóndilo”.

Con los hallazgos encontrados en este estudio, y mientras no se publiquen otros estudios complementarios, no recomendamos la reconstrucción del LCA con la técnica de túneles transfisiarios, ni la reconstrucción con la técnica “sobre el cóndilo”, en pacientes con esqueleto inmaduro.

Abstract

In order to compare two different techniques of reconstruction of the anterior cruciate ligament (ACL) in inmature skeletons, a canine experimental study was carried out to evaluate its clinical and histological physeal outcome. 16 domestic dogs were operated on at 2and 3 months of age. A total resection of the ACL was done in all of the specimens, and then the defect was reconstructed with a conventional iliotibial band technique. The specimens were divided into two study groups of 8 dogs each. In the first group (A), the ACL was reconstructed with trans-physeal insertion of the graft, whereas in the second group (B) the over-the-top technique was performed. Four dogs of each group were sacrificed at 6 and 12 weeks after surgery. A histomorphometric analysis was carried out by measuring the thickness of the physeal plate, the presence or absence of bone bridges, and the loss of thecellular pattern. All of these parameters were compared with contralateral controls. The total length of femur, tibia and limb were measured and compared with contralateral controls at 6 and 12 weeks after surgery. All results were compared by a paired T-test and a two way analysis of variance, as well as the normalized results comparing the differences between the operated bones and their contralateral controls. The average reduction in physeal thickness between the 6th and 12th weeks was significantly larger in the specimens operated with transphyseal tunnels, suggesting a physeal closure effect. The average reduction of the physeal closure was smaller in the over-the-top specimens as compared with their controls, suggesting an inhibitory effect on physeal closure, probably due to some kind of external effect on the physis. In both the over-the-top and tunnelized tibias we found a larger reduction of the physeal thickness on the outside mark, suggesting a faster closure on the external middle of the plate. This effect may result in angular deformity over time in both techniques. We did not find any bone length discrepancy between o within groups after 12 weeks of surgery, and no correlation with the histologic findings. The significant changes in physeal thickness, cell pattern and physeal closure leads us to conclude that there is a certain effect of both types of ACL reconstructions on the growth plate in the inmature skeleton. This behavior is not clinically relevant in our 12 week study, and this histological behavior must be explained in more detailed further studies.

Key words: Anterior cruciate ligament, growth plate, dogs.

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