Koch Peter P, Fucentese Sandro F, Blatter Samuel C
Department of Orthopaedic Surgery and Traumatology, Kantonsspital Winterthur, Brauerstrasse 15, Postfach 834, 8401, Winterthur, Switzerland.
Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2016 Sep;24(9):2736-2740. doi: 10.1007/s00167-014-3396-4. Epub 2014 Oct 26.
Reconstruction of the anterior cruciate ligament (ACL) remains a major concern in the prepubescent, skeletally immature patient with wide open growth plates. Different surgical techniques have been proposed. This study reports the results and complications of ACL reconstruction in young children using an all epiphyseal technique.
Between 2006 and 2010, 12 patients (10-13 years, median 12.1 years) underwent epiphyseal primary ACL reconstruction, with a total of 13 knee procedures. Patients were assessed retrospectively with a median follow-up of 54 months (range 39-80 months) consisting of a clinical examination, instrumented arthrometer testing and radiological analysis. Functional status was assessed using the Lysholm knee score, Tegner activity scale and IKDC-2000 form.
According to the IKDC examination form, five knees were rated as normal, six near normal and two abnormal. The median IKDC score at follow-up was 88.5 points (range 75-99 points). The mean side-to-side difference in KT-1000 ligament laxity testing was 1.5 mm (±2.5 mm). In two patients, reoperation was necessary due to graft failure. Two patients developed significant leg length inequality; one with 20 mm overgrowth and varus malalignment after re-reconstruction and the second developed arthrofibrosis and overgrowth of 16 mm. Four patients had minor limb length discrepancy ranging between +5 and +10 mm; no growth arrest was noted. One patient with an intact but slightly elongated graft required a meniscal suture 34 months after ACL reconstruction following a traumatic medial meniscal lesion.
Despite using the epiphyseal technique in ACL reconstruction, relevant growth discrepancy can occur. Thereby, overgrowth rates appear to potentially pose a major clinical problem, which has remained unreported so far. Overall, there is a considerable high risk of complications in this patient group.
IV.
对于青春期前骨骼未成熟且生长板完全开放的患者，前交叉韧带（ACL）重建仍是一个主要问题。已经提出了不同的手术技术。本研究报告了使用全骨骺技术对年幼儿童进行ACL重建的结果及并发症。
2006年至2010年期间，12例患者（年龄10 - 13岁，中位年龄12.1岁）接受了骨骺原位ACL重建，共进行了13例膝关节手术。对患者进行回顾性评估，中位随访时间为54个月（范围39 - 80个月），评估内容包括临床检查、仪器化关节测角仪测试和影像学分析。使用Lysholm膝关节评分、Tegner活动量表和IKDC - 2000表格评估功能状态。
根据IKDC检查表格，5个膝关节评定为正常，6个接近正常，2个异常。随访时IKDC评分中位数为88.5分（范围75 - 99分）。KT - 1000韧带松弛度测试的平均两侧差异为1.5毫米（±2.5毫米）。2例患者因移植物失败需要再次手术。2例患者出现明显的腿长不等；1例在再次重建后有20毫米的过度生长和内翻畸形，另1例出现关节纤维性变和16毫米的过度生长。4例患者有轻微的肢体长度差异，范围在 +5至 +10毫米之间；未观察到生长停滞。1例移植物完整但略延长的患者在ACL重建34个月后因内侧半月板创伤性损伤需要进行半月板缝合。
尽管在ACL重建中使用了骨骺技术，但仍可能出现相关的生长差异。因此，过度生长率似乎可能构成一个主要的临床问题，而这一问题迄今尚未见报道。总体而言，该患者群体存在相当高的并发症风险。
IV级。
