Norwegian Research Centre for Active Rehabilitation, Department of Sports Medicine, Norwegian School of Sport Sciences, PB 4014 Ullevål Stadion, 0806 Oslo, Norway.
J Bone Joint Surg Am. 2012 Jun 20;94(12):1112-9. doi: 10.2106/JBJS.K.00960.
There is no consensus on the management of anterior cruciate ligament (ACL) injuries in skeletally immature children, and the methodological quality of published studies is questionable. The transphyseal reconstructions, physeal-sparing reconstructions, and nonoperative treatment algorithms that are advocated have little support in the literature. The purpose of this study was to systematically review the methodological quality of the literature on the management of ACL injuries in skeletally immature children.
We performed a literature search with use of PubMed to identify prospective or retrospective studies whose primary aim was to assess the outcome after operative or nonoperative treatment of ACL injuries in skeletally immature children. To be included in the analysis, a study had to have a mean duration of follow-up of at least two years and a minimum of ten children in the study had to be verified to be skeletally immature. The methodological quality of the included studies was evaluated with use of the Coleman Methodology Score.
No randomized controlled trials, two prospective cohort studies, and twenty-nine retrospective studies met the inclusion criteria. The Coleman Methodology Score averaged 44.7 ± 9.2 out of 100 (range, 28 to 62). The methodological deficiencies were most evident with regard to the number of included children, the study design, and the description of rehabilitation protocols, outcome criteria, and outcome assessments.
Caution is necessary when interpreting the results of studies on the treatment of ACL injuries in skeletally immature children because of widespread methodological deficiencies. There is a need for appropriately sized prospective studies and detailed descriptions of rehabilitation programs.
对于骨骼未成熟儿童的前交叉韧带（ACL）损伤，目前尚无共识，且已发表研究的方法学质量存在疑问。有研究提倡经骺板重建、骺板保存重建和非手术治疗方案，但这些方案在文献中几乎没有得到支持。本研究旨在系统评价骨骼未成熟儿童 ACL 损伤治疗的文献的方法学质量。
我们通过 PubMed 进行文献检索，以确定主要目的为评估骨骼未成熟儿童 ACL 损伤手术或非手术治疗后结局的前瞻性或回顾性研究。分析纳入标准为：平均随访时间至少 2 年，且研究中至少有 10 例被证实为骨骼未成熟的儿童。采用 Coleman 方法学评分评估纳入研究的方法学质量。
无随机对照试验、2 项前瞻性队列研究和 29 项回顾性研究符合纳入标准。Coleman 方法学评分平均为 100 分中的 44.7 ± 9.2 分（范围，28 分至 62 分）。方法学缺陷最明显的是纳入儿童的数量、研究设计以及康复方案、结局标准和结局评估的描述。
由于存在广泛的方法学缺陷，在解释骨骼未成熟儿童 ACL 损伤治疗研究的结果时需谨慎。需要进行适当大小的前瞻性研究，并详细描述康复方案。
