Calvo Rafael, Figueroa David, Gili Federico, Vaisman Alex, Mocoçain Pablo, Espinosa Maximiliano, León Agustín, Arellano Sergio
Orthopaedic Surgery Department, Clínica Alemana Santiago, Santiago, Chile.
Orthopaedic Surgery Department, Clínica Alemana Santiago, Santiago, Chile
Am J Sports Med. 2015 Feb;43(2):289-94. doi: 10.1177/0363546514557939. Epub 2014 Nov 17.
The treatment of anterior cruciate ligament (ACL) injuries in skeletally immature patients is controversial. Current evidence supports the view that surgical techniques restore knee stability and prevent progressive articular damage. However, most of the studies on this topic are small case series or they have short- or medium-term follow-up times.
To determine the long-term functional outcomes and secondary complications of transphyseal intra-articular ACL reconstruction with hamstring graft in skeletally immature patients.
Case series; Level of evidence, 4.
Transphyseal ACL reconstruction with autograft hamstrings was performed in 27 skeletally immature patients. The average age at surgery was 13 years (range, 12-16 years), and the average follow-up time was 10.6 years (range, 10-13 years). Clinical outcomes were assessed with preoperative and final follow-up Tegner, International Knee Documentation Committee (IKDC) subjective, and Lysholm scores. Surgery details, return to sports, and ACL reconstruction failures were collected. The anteroposterior knee laxity was assessed by arthrometry, and the presence of deformities and lower limb length discrepancies were evaluated by radiographs. The presence of degenerative signs on anteroposterior and lateral knee radiographs at final follow-up was also evaluated.
Transphyseal ACL reconstruction was performed with vertically oriented tunnels, 7 to 10 mm in diameter, using semitendinosus-gracilis autograft. The average preoperative Tegner, IKDC, and Lysholm scores were 7, 55, and 40, respectively. Significant differences in these scores were observed at the time of the final assessment (Tegner, 6 [P = .026]; IKDC, 94 [P < .001]; Lysholm, 92 [P < .001]). Two patients reported instability during sports activity. Three patients had a rupture of the ACL graft. No leg length discrepancy, axis malalignment, or degenerative changes were observed.
The transphyseal ACL reconstruction in skeletally immature patients is a safe option, with high functional and satisfaction results, without significant growth plate damage in this series of patients.
骨骼未成熟患者前交叉韧带（ACL）损伤的治疗存在争议。目前的证据支持手术技术可恢复膝关节稳定性并预防进行性关节损伤这一观点。然而，关于该主题的大多数研究都是小病例系列，或者随访时间为短期或中期。
确定在骨骼未成熟患者中采用腘绳肌移植物进行经骨骺关节内ACL重建的长期功能结果和继发性并发症。
病例系列；证据等级，4级。
对27例骨骼未成熟患者进行了经骨骺自体腘绳肌ACL重建。手术时的平均年龄为13岁（范围12 - 16岁），平均随访时间为10.6年（范围10 - 13年）。通过术前和最终随访时的Tegner评分、国际膝关节文献委员会（IKDC）主观评分和Lysholm评分评估临床结果。收集手术细节、恢复运动情况和ACL重建失败情况。通过关节测量评估膝关节前后向松弛度，通过X线片评估畸形和下肢长度差异的存在情况。还评估了最终随访时膝关节前后位和侧位X线片上的退变征象。
采用直径7至10毫米的垂直定向隧道，使用半腱肌 - 股薄肌自体移植物进行经骨骺ACL重建。术前Tegner、IKDC和Lysholm评分的平均值分别为7、55和40。在最终评估时，这些评分有显著差异（Tegner，6 [P = .026]；IKDC，94 [P < .001]；Lysholm，92 [P < .001]）。两名患者在体育活动中报告有不稳定感。三名患者出现ACL移植物断裂。未观察到下肢长度差异、轴线排列不齐或退变改变。
在骨骼未成熟患者中进行经骨骺ACL重建是一种安全的选择，功能和满意度结果良好，在这一系列患者中未出现明显的生长板损伤。
