Sports Medicine Department, Medical Centre, Distomou 5-7, Marousi, Athens, Greece.
Knee Surg Sports Traumatol Arthrosc. 2011 May;19(5):801-5. doi: 10.1007/s00167-010-1375-y. Epub 2011 Feb 3.
Significant controversy exists regarding the potential harm to the growth plate following reconstruction of the anterior cruciate ligament in skeletally immature patients. This study was performed to evaluate the results of a transepiphyseal replacement of the anterior cruciate ligament in skeletally immature patients.
Ninety-four skeletally immature patients (56 male and 38 female) with median age 13.7 years (range, 11.6-15.9 years) who underwent arthroscopic transphyseal reconstruction of anterior cruciate ligament with four-strand medial hamstring autograft between 1999 and 2006 were reviewed. All patients had been followed up until skeletal maturity was confirmed.
The average follow-up was 38 months (range 24-60 months). Neither leg length discrepancy nor angular deformities were noted on radiological or clinical measurement. Two patients had radiographic evidence of mild arthrosis at final follow-up. New traumatic injuries occurred in 4 patients, in whom surgical revision was performed. Ligament laxity testing with a KT 1000/2000 arthrometer showed no significant difference between the normal and the operated legs. At follow-up, the median Lysholm score was 89 (range 77-100), and the median Tegner activity score was increased from 3 to 6. The International Knee Documentation Committee score was A in 79 patients (84%) and B in 6 patients (6%) and C in 9 patients (9%). Of the 94 patients, 73 (78%) returned to their similar preoperative sport activities and 90% returned to their preoperative level of daily activities.
ACL reconstruction with medial hamstring autograft via transepiphyseal drilling and grafting yielded satisfactory clinical results with no growth defects in skeletally immature patient. The preliminary results of this series demonstrated that this surgical technique can be performed in prepubescent patients with efficacy and safety.
IV.
在骨骼未成熟的患者中重建前交叉韧带后，生长板可能受到损伤，这一问题存在较大争议。本研究旨在评估经骺板钻孔移植四股腘绳肌腱重建前交叉韧带治疗骨骼未成熟患者的效果。
1999 年至 2006 年，我们对 94 例骨骼未成熟（男 56 例，女 38 例；中位年龄 13.7 岁，范围 11.6～15.9 岁）患者进行了关节镜下经骺板前交叉韧带四股腘绳肌腱重建术。所有患者均随访至骨骼成熟。
平均随访 38 个月（范围 24～60 个月）。影像学和临床测量均未发现肢体长度差异或角度畸形。末次随访时，2 例患者有轻度关节炎的放射学证据。4 例患者发生新的创伤性损伤，均进行了手术翻修。KT-1000/2000 关节测量仪测量的韧带松弛度测试显示，正常侧与手术侧之间无显著差异。随访时，Lysholm 评分中位数为 89（范围 77～100），Tegner 活动评分从 3 分增加至 6 分。国际膝关节文献委员会（IKDC）评分 A 级 79 例（84%），B 级 6 例（6%），C 级 9 例（9%）。94 例患者中，73 例（78%）恢复到术前相似的运动水平，90%恢复到术前日常活动水平。
经骺板钻孔移植四股腘绳肌腱重建前交叉韧带治疗骨骼未成熟患者可获得满意的临床效果，无生长缺陷。本系列初步结果表明，该手术技术可安全有效地应用于青春期前患者。
IV 级。
