Cohen Moises, Ferretti Mario, Quarteiro Marcelo, Marcondes Frank B, de Hollanda João P B, Amaro Joicemar T, Abdalla Rene J
Orthopedic Sports Medicine Division, Department of Orthopaedic Surgery and Traumatology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil.
Arthroscopy. 2009 Aug;25(8):831-8. doi: 10.1016/j.arthro.2009.01.015.
The purpose of this study was to evaluate the clinical outcomes of transphyseal anterior cruciate ligament (ACL) reconstruction in patients with open physes.
Transphyseal ACL reconstruction was performed in 26 patients with open tibial and femoral physes (physis >2 mm) by use of autogenous quadrupled hamstrings as grafts. Meniscal tearing was found in 65.3% of the patients. Partial chondral defect injury on the medial femoral condyle was found 6 months after injury in only 2 patients (7.69% of all patients). The mean follow-up period was 45 +/- 18.3 months. Clinical outcomes were evaluated by use of the International Knee Documentation Committee score and Lysholm Knee Scoring Scale, and the anteroposterior stability was objectively measured by use of KT-1000 arthrometer (MEDmetric, San Diego, CA). Possible length and angular discrepancies were observed by conventional radiography in a long film and scanograms of the lower limbs.
The mean length discrepancy between the operated lower limb and the contralateral limb was 1.2 +/- 3.2 mm (range, -7 to 7 mm). The mean angular deviation difference between the lower limbs was 0.46 degrees +/- 1.1 degrees . New traumatic injuries developed in 3 patients, in whom surgical revision was performed; 1 patient underwent a late meniscectomy. The mean difference in KT-1000 measurement was 2.0 +/- 1.0 mm. The mean subjective International Knee Documentation Committee score was 91.5 +/- 5.7, and the mean score on the modified Lysholm scale was 93.5 +/- 4. Of the patients, 3 (11.2% of all patients) could not return to the same level of physical activity as before injury.
ACL reconstruction by use of the transphyseal technique in an immature skeleton with a hamstring autograft, with careful attention being paid to the technique, resulted in good clinical outcomes and no growth abnormalities.
Level IV, therapeutic case series.
本研究旨在评估开放性骨骺患者经骨骺前交叉韧带(ACL)重建的临床疗效。
对26例胫骨和股骨骨骺开放(骨骺>2mm)的患者采用自体四股腘绳肌腱作为移植物进行经骨骺ACL重建。65.3%的患者存在半月板撕裂。仅2例患者(占所有患者的7.69%)在伤后6个月发现股骨内侧髁部分软骨缺损损伤。平均随访时间为45±18.3个月。采用国际膝关节文献委员会评分和Lysholm膝关节评分量表评估临床疗效,使用KT-1000关节测量仪(MEDmetric,圣地亚哥,加利福尼亚州)客观测量前后稳定性。通过常规下肢全长片和扫描图观察可能存在的长度和角度差异。
手术侧下肢与对侧下肢的平均长度差异为1.2±3.2mm(范围为-7至7mm)。下肢平均角度偏差差异为0.46°±1.1°。3例患者出现新的创伤性损伤并接受了手术翻修;1例患者接受了晚期半月板切除术。KT-1000测量的平均差异为2.0±1.0mm。国际膝关节文献委员会主观平均评分为91.5±5.7,改良Lysholm量表平均评分为93.5±4。3例患者(占所有患者的11.2%)无法恢复到伤前的体力活动水平。
在未成熟骨骼中采用经骨骺技术并用腘绳肌自体移植物进行ACL重建,在技术操作上加以仔细注意,可取得良好的临床疗效且无生长异常。
IV级,治疗性病例系列。