Cordasco Frank A, Mayer Stephanie Watson, Green Daniel W
Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA.
Pediatric Orthopaedic Surgery, Children's Hospital Colorado, Aurora, Colorado, USA.
Am J Sports Med. 2017 Mar;45(4):856-863. doi: 10.1177/0363546516677723. Epub 2016 Dec 27.
Anterior cruciate ligament (ACL) injuries in skeletally immature athletes are increasing.
To evaluate the 2-year clinical outcomes of all-inside, all-epiphyseal ACL reconstruction in skeletally immature athletes with 3 to 6 years of remaining growth, with a focus on return to sport and the incidence of second surgery.
Case series; Level of evidence, 4.
Twenty-three skeletally immature athletes were prospectively evaluated after all-epiphyseal ACL reconstruction utilizing a hamstring autograft. The athletes' age, sex, sport, mechanism of injury, radiographs, and magnetic resonance imaging (MRI) findings were noted. The evaluation included a physical examination, KT-1000 arthrometer measurements, isokinetic testing, and validated outcome scores. Standing radiographs and spoiled gradient recalled echo MRI scans were obtained at 6, 12, and 24 months postoperatively. A quality of movement assessment and return-to-sport performance analysis were also performed.
Of the 23 athletes, 6 were female (mean age, 11.3 years), and 17 were male (mean age, 12.6 years). At a minimum follow-up of 2 years (range, 24-45 months), the mean International Knee Documentation Committee score was 94.6 ± 4.9, the mean Lysholm score was 97.9 ± 4.0, the mean Marx activity rating scale score was 13.4 ± 3.6, and the mean Hospital for Special Surgery Pediatric Functional Activity Brief Scale score was 23.9 ± 7.0. Lachman and pivot-shift test results were negative in all patients. The mean side-to-side difference on the KT-1000 arthrometer was 0.9 ± 0.5 mm and less tight on the operated side. No significant growth disturbances were noted; however, 6 athletes had a leg-length discrepancy of more than 5 mm (range, 6-18 mm). Two patients had overgrowth in the femur of more than 15 mm (16 mm and 18 mm). Two athletes (8.7%) required second surgery. The mean time to return to unrestricted activity was 13.5 months (range, 8-22 months).
The all-inside, all-epiphyseal ACL reconstruction technique using a hamstring autograft demonstrates excellent subjective and objective clinical outcomes in skeletally immature athletes without physeal arrest.
骨骼未成熟运动员的前交叉韧带（ACL）损伤正在增加。
评估骨骼未成熟且还有3至6年生长时间的运动员采用全内、全骨骺ACL重建术后2年的临床结果，重点关注恢复运动情况和二次手术发生率。
病例系列；证据等级，4级。
对23名骨骼未成熟运动员在采用腘绳肌自体移植物进行全骨骺ACL重建术后进行前瞻性评估。记录运动员的年龄、性别、运动项目、损伤机制、X线片以及磁共振成像（MRI）结果。评估包括体格检查、KT-1000关节测量仪测量、等速测试以及经过验证的结果评分。术后6个月、12个月和24个月获取站立位X线片和扰相梯度回波MRI扫描。还进行了运动质量评估和恢复运动表现分析。
23名运动员中，6名女性（平均年龄11.3岁），17名男性（平均年龄12.6岁）。在至少2年的随访期（范围24 - 45个月）内，国际膝关节文献委员会平均评分为94.6±4.9，Lysholm平均评分为97.9±4.0，马克思活动评分量表平均评分为13.4±3.6，特殊外科医院儿童功能活动简要量表平均评分为23.9±7.0。所有患者的Lachman试验和轴移试验结果均为阴性。KT-1000关节测量仪测量的平均双侧差异为0.9±0.5mm，患侧较松弛。未发现明显的生长紊乱；然而，6名运动员存在超过5mm（范围6 - 18mm）的腿长差异。2例患者股骨过度生长超过15mm（16mm和18mm）。2名运动员（8.7%）需要二次手术。恢复无限制活动的平均时间为13.5个月（范围8 - 22个月）。
采用腘绳肌自体移植物的全内、全骨骺ACL重建技术在骨骼未成熟且未发生骨骺阻滞的运动员中显示出优异的主观和客观临床结果。
