Parikh Shital N, Jaquith Bradley P, Brusalis Christopher M, Redler Lauren H, Ganley Theodore J, Kocher Mininder S
Associate Professor of Orthopaedic Surgery, Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Instr Course Lect. 2017 Feb 15;66:461-474.
At one time, anterior cruciate ligament (ACL) tears in skeletally immature patients were considered rare. The recommended treatment option for skeletally immature patients with ACL tears was to modify activities until skeletal maturity, at which point definitive ACL reconstruction could be safely performed. The management of ACL tears in skeletally immature patients has evolved as a result of the increased frequency of ACL tears in younger patients and an increased awareness for the potential development or worsening of meniscal tears, chondral lesions, and degenerative changes that occur with the "wait-and-fix-later" approach. The surgical options for ACL reconstruction in skeletally immature patients include physeal-sparing, partial transphyseal, and complete transphyseal techniques. The timing and ideal technique for ACL reconstruction in skeletally immature patients are controversial. Accurate assessment of skeletal growth remaining and concerns for iatrogenic growth disturbances continually challenge treating physicians. Similar controversies with regard to the treatment of skeletally immature patients who have partial ACL tears or congenital absence of the ACL also exist.
曾经，骨骼未成熟患者的前交叉韧带（ACL）撕裂被认为较为罕见。对于骨骼未成熟的ACL撕裂患者，推荐的治疗方案是调整活动，直至骨骼成熟，届时可安全地进行确定性ACL重建。由于年轻患者中ACL撕裂的频率增加，以及人们对“等待并后期修复”方法可能导致半月板撕裂、软骨损伤和退行性改变的潜在发展或恶化的认识提高，骨骼未成熟患者ACL撕裂的管理方法已经有所发展。骨骼未成熟患者ACL重建的手术选择包括保留骨骺、部分经骨骺和完全经骨骺技术。骨骼未成熟患者ACL重建的时机和理想技术存在争议。准确评估剩余的骨骼生长以及对医源性生长紊乱的担忧持续挑战着治疗医生。对于部分ACL撕裂或先天性ACL缺失的骨骼未成熟患者的治疗，也存在类似的争议。
