Dei Giudici Luca, Fabbrini Roberto, Garro Luca, Arima Serena, Gigante Antonio, Tucciarone Agostino
Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, School of Medicine, Università Politecnica delle Marche, Italy.
Department of Orthopaedics, Istituto Chirurgico Ortopedico Traumatologico ICOT, Latina, Italy.
J Orthop Surg (Hong Kong). 2016 Dec;24(3):307-311. doi: 10.1177/1602400307.
To evaluate the 5-year outcome of arthroscopic transphyseal anterior cruciate ligament (ACL) reconstruction in 19 adolescent athletes.
14 male and 5 female adolescent athletes aged 12 to 16 (mean, 13.9) years with Tanner stage 2 or 3 open physes underwent arthroscopic transphyseal ACL reconstruction by a single surgeon and were followed up for 5 years. Patients were evaluated using the numerical rating score (NRS) for pain, knee osteoarthritis outcome score (KOOS), International Knee Documentation Committee (IKDC) score, Tegner Activity Scale, and Lysholm Score, as well as the leg length discrepancy, femorotibial alignment, varus or valgus deformities, active and passive knee range of motion.
At 5-year follow-up, physes were closed in all patients. The mean NRS for pain improved from 7.2 to 1.6; the KOOS improved from 55.3 to 88; the mean IKDC score improved from 34.5 to 84; the mean Tegner Activity Scale improved from 2.7 to 8.2 and was comparable with that before injury (8.4); and the mean Lysholm score improved from 36.3 to 84.6. All except 2 patients returned to their pre-injury level of sports activity after a mean of 25 weeks. The 2 exceptions had a 2+ Jerk test and a 3+ Lachman test; one of them also had positive signs for a lateral meniscal lesion. Both had sustained a second trauma not long before the 5-year follow-up. Two patients had reduced sensitivity in the anteromedial aspect of the proximal third of the tibia. One patient had leg length discrepancy of +1.5 cm owing to overgrowth response of the physis.
Transphyseal ACL reconstruction is a viable option for skeletally immature patients, with high reproducibility, a high rate of return to sport, and a low incidence of growth disturbance. Early surgery can prevent the onset of meniscal lesions and early osteoarthritis.
评估19名青少年运动员关节镜下经骨骺前交叉韧带（ACL）重建的5年疗效。
14名男性和5名女性青少年运动员，年龄12至16岁（平均13.9岁），处于 Tanner 2期或3期开放骨骺，由同一位外科医生进行关节镜下经骨骺ACL重建，并随访5年。使用数字疼痛评分（NRS）、膝关节骨关节炎结局评分（KOOS）、国际膝关节文献委员会（IKDC）评分、Tegner活动量表和Lysholm评分对患者进行评估，同时评估下肢长度差异、股胫对线、内翻或外翻畸形、膝关节主动和被动活动范围。
在5年随访时，所有患者的骨骺均已闭合。疼痛的平均NRS评分从7.2改善至1.6；KOOS评分从55.3提高到88；平均IKDC评分从34.5提高到84；平均Tegner活动量表评分从2.7提高到8.2，与受伤前（8.4）相当；平均Lysholm评分从36.3提高到84.6。除2名患者外，所有患者平均在25周后恢复到受伤前的体育活动水平。这2名患者的Jerk试验为2+，Lachman试验为3+；其中1名患者外侧半月板损伤也呈阳性体征。两人在5年随访前不久均遭受了第二次创伤。2名患者胫骨近端三分之一前内侧的感觉减退。1名患者因骨骺过度生长反应出现1.5 cm的下肢长度差异。
经骨骺ACL重建对于骨骼未成熟患者是一种可行的选择，具有高重复性、高重返运动率和低生长障碍发生率。早期手术可预防半月板损伤和早期骨关节炎的发生。
