Service de Chirurgie Orthopédique Pédiatrique, Hôpital Universitaire Femme Mère Enfant de Lyon, Université Claude Bernard Lyon I, 59 Boulevard Pinel, Bron, France.
Knee Surg Sports Traumatol Arthrosc. 2010 Nov;18(11):1496-500. doi: 10.1007/s00167-010-1069-5. Epub 2010 Feb 25.
Growth arrest is a major concern after ACL reconstruction in children. It usually occurs in patients near to closure of the growth plates. Growth disturbances without growth arrest are also possible and more vicious; the authors analyse the mechanism of two patients with growth disturbance due to overgrowth following ACL reconstruction. One was a symmetrical overgrowth process with 15 mm limb length discrepancy treated with percutaneous epiphysiodesis. Full correction at the time of skeletal maturity was achieved. The second patient developed an asymmetrical overgrowth with progressive tibial valgus deformity. This mechanism was similar to a posttraumatic tibial valgus deformity. After nonoperative treatment, a spontaneous correction of the deformity was noticed. Both children were young (7 and 10 years old) at the time of ACL reconstruction with an autologous iliotibial band graft. The clinical relevance of overgrowth disturbance is usually limited when compared to growth arrest but could require a second surgical procedure as reported in this study. Parents must be informed that even in experienced hands, and despite the use of a physeal sparing technique, this specific risk of growth disturbance is still present.
生长停滞是儿童前交叉韧带重建术后的主要关注点。它通常发生在接近生长板闭合的患者中。生长阻滞的生长障碍也可能更严重；作者分析了两例因前交叉韧带重建后过度生长导致生长障碍的患者的机制。一例为 15mm 肢体长度差异的对称性过度生长，采用经皮骺板固定术治疗。在骨骼成熟时完全纠正。第二位患者出现了不对称性过度生长和进行性胫骨外旋畸形。这种机制类似于创伤后胫骨外旋畸形。经过非手术治疗，畸形自发矫正。两例患者均为儿童（7 岁和 10 岁），在前交叉韧带重建时使用自体髂胫束移植物。与生长阻滞相比，过度生长障碍的临床相关性通常有限，但正如本研究报道的那样，可能需要进行第二次手术。家长必须被告知，即使在有经验的医生手中，尽管使用了保留骺板的技术，这种特定的生长障碍风险仍然存在。
