Dorizas John A, Stanitski Carl L
Department of Orthopedic Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, P.O. Box 250622, Charleston, SC 29425, USA.
Orthop Clin North Am. 2003 Jul;34(3):355-63. doi: 10.1016/s0030-5898(02)00072-x.
Although ACL injuries in truly skeletally immature patients are relatively uncommon events, they are experienced more frequently than initially reported--especially in the adolescent population. Natural history data is limited but appears to mirror the natural history in adults with this injury if return to high-risk activity is allowed. Treatment of this injury presents unique challenges because of the substantial growth that occurs through the distal femoral and proximal tibial physes. The physiologic skeletal maturity of the patient must be determined prior to deciding treatment. Techniques of reconstruction include physeal sparing, partial transphyseal, and transphyseal methods. Reconstruction is recommended for any patient with an "ACL +" knee (a complete ACL tear and concomitant meniscal injury) or one who is non-compliant with a nonoperative treatment program and develops symptoms of persistent instability. Short-term outcomes of functional return postreconstruction appear promising, but study numbers are small and follow-up times relatively brief in truly immature patients. Long-term outcome studies are still needed.
虽然在真正骨骼未成熟的患者中，前交叉韧带（ACL）损伤相对不常见，但实际发生频率比最初报道的要高，尤其是在青少年人群中。自然史数据有限，但如果允许恢复高风险活动，其似乎反映了患有这种损伤的成年人的自然史。由于通过股骨远端和胫骨近端骨骺会发生显著生长，这种损伤的治疗面临独特挑战。在决定治疗之前，必须确定患者的生理骨骼成熟度。重建技术包括保留骨骺、部分经骨骺和经骨骺方法。对于任何患有“ACL +”膝关节（完全ACL撕裂并伴有半月板损伤）的患者，或不遵守非手术治疗方案并出现持续不稳定症状的患者，建议进行重建。重建后功能恢复的短期结果似乎很有希望，但真正未成熟患者的研究数量较少，随访时间相对较短。仍需要长期结果研究。
