Cassard Xavier, Cavaignac Etienne, Maubisson Laurent, Bowen Mark
*Clinique des Cèdres, Cornebarrieu †CHU Rangueil1 avenue du Professeur Pouilhes ‡ESG Management School and Université Toulouse 1, Toulouse, France §NorthShore Orthopaedics, Chicago, IL.
J Pediatr Orthop. 2014 Jan;34(1):70-7. doi: 10.1097/BPO.0b013e3182a008b6.
The management of anterior cruciate ligament (ACL) tears in growing patients must balance activity modification with the risk of secondary (meniscal and cartilaginous) lesions, and surgical intervention, which could adversely affect skeletal growth. Many ACL reconstruction techniques have been developed or modified to decrease the risk of growth disturbance. We have not found any description of ACL reconstruction using a single hamstring, short graft implanted into intraepiphyseal, retroreamed sockets. Our hypothesis was that the technique that we used restored the knee stability and did not cause any growth disturbances.
We retrospectively studied 28 patients (20 boys, 8 girls) who presented with a unilateral ACL tear and open growth plates. We performed short graft ligament reconstruction with the semitendinosus folded into 4 strands around 2 polyethylene terephthalate tapes. The graft was implanted into sockets that were retroreamed in the femoral and tibial epiphysis and the tapes were fixed remotely by interference screws. After a minimum period of 2 years, we evaluated the comparative knee laxity, the radiographic limb morphology, the appearance of secondary lesions, and the functional outcomes using the Lysholm and Tegner scores. Comparative analyses were performed using the Student t test with subgroups depending on the type of fixation used.
The mean age of the patients was 13 years (range, 9 to 15 y). The mean follow-up was 2.8 years (range, 2 to 5 y). The mean difference in laxity at 134 N was 0.3 mm, as determined using a GNRB arthrometer. No patients reported meniscal symptoms or degenerative changes. We found no angular deformity or leg length inequality. Two patients suffered a recurrent ACL tear.
The preliminary results from this series are consistent with prior studies demonstrating that intraepiphyseal ACL reconstruction is a safe reliable alternative for the pediatric population.
Case series; level of evidence 4.
对于生长发育期患者的前交叉韧带（ACL）撕裂的治疗，必须在限制活动与继发（半月板和软骨）损伤风险之间取得平衡，同时还要考虑可能对骨骼生长产生不利影响的手术干预。已经开发或改进了许多ACL重建技术以降低生长发育障碍的风险。我们尚未发现任何关于使用单根腘绳肌短移植物植入骨骺内、逆行扩髓骨隧道进行ACL重建的描述。我们的假设是，我们所采用的技术能够恢复膝关节稳定性，且不会导致任何生长发育障碍。
我们回顾性研究了28例单侧ACL撕裂且生长板开放的患者（20例男孩，8例女孩）。我们采用半腱肌折叠成4股围绕2根聚对苯二甲酸乙二酯带进行短移植物韧带重建。移植物植入股骨和胫骨骨骺中逆行扩髓的骨隧道，并用挤压螺钉在远处固定带子。经过至少2年的随访，我们使用Lysholm和Tegner评分评估了膝关节相对松弛度、影像学肢体形态、继发损伤的表现以及功能结果。根据所用固定类型进行亚组分析，采用Student t检验进行比较分析。
患者的平均年龄为13岁（范围9至15岁）。平均随访时间为2.8年（范围2至5年）。使用GNRB关节测量仪测定，在134 N力下松弛度的平均差异为0.3 mm。没有患者报告半月板症状或退变改变。我们未发现角畸形或腿长不等。2例患者出现ACL撕裂复发。
本系列的初步结果与先前的研究一致，表明骨骺内ACL重建对于儿童人群是一种安全可靠的替代方法。
病例系列；证据等级4。
