Richter Dustin Jon, Lyon Roger, Van Valin Scott, Liu Xue-Cheng
Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.
Department of Orthopaedic Surgery, Children's Hospital of Wisconsin, Milwaukee, WI, United States.
Front Surg. 2018 Apr 30;5:36. doi: 10.3389/fsurg.2018.00036. eCollection 2018.
The incidence of anterior cruciate ligament (ACL) injuries in the pediatric population has risen in recent years. These injuries have historically presented a management dilemma in skeletally immature patients with open physes and significant growth remaining at time of injury. While those nearing skeletal maturity may be treated with traditional, transphyseal adult techniques, these same procedures risk iatrogenic damage to the growth plates and resultant growth disturbances in younger patients with open physes. Moreover, conservative management is non-optimal as significant instabilities of the knee remain. Despite the development of physeal-sparing reconstructive techniques for younger patients, there remains debate over which procedure may be most suitable on a patient to patient basis. Meanwhile, the drivers behind clinical and functional outcomes following ACL reconstruction remain poorly understood. Therefore, current strategies are not yet capable of optimizing surgical ACL reconstruction on an individualized basis with absolute confidence. Instead, aims to improve surgical treatment of ACL tears in skeletally immature patients will rely on additional approaches in the near future. Namely, finite element models have emerged as a tool to model complex knee joint biomechanics. The inclusion of several individualized variables such as bone age, three dimensional geometries around the knee joint, tunnel positioning, and graft tension collectively present a possible means of better understanding and even predicting how to enhance surgical decision-making. Such a tool would serve surgeons in optimizing ACL reconstruction in the skeletally immature individuals, in order to improve clinical outcomes as well as reduce the rate of post-operative complications.
近年来，儿科人群中前交叉韧带（ACL）损伤的发生率有所上升。从历史上看，这些损伤在骨骼未成熟、骨骺开放且受伤时仍有显著生长的患者中带来了治疗难题。虽然接近骨骼成熟的患者可以采用传统的经骨骺成人技术进行治疗，但这些相同的手术有对生长板造成医源性损伤以及导致骨骺开放的年轻患者出现生长紊乱的风险。此外，保守治疗并非最佳选择，因为膝关节仍存在明显不稳定。尽管已为年轻患者开发了保留骨骺的重建技术，但对于哪种手术在个体患者基础上可能最合适仍存在争议。与此同时，ACL重建后临床和功能结果背后的驱动因素仍知之甚少。因此，目前的策略还无法绝对自信地在个体基础上优化手术ACL重建。相反，在不久的将来，旨在改善骨骼未成熟患者ACL撕裂手术治疗的目标将依赖于其他方法。具体而言，有限元模型已成为一种模拟复杂膝关节生物力学的工具。纳入诸如骨龄、膝关节周围的三维几何形状、隧道定位和移植物张力等几个个体化变量，共同提供了一种更好地理解甚至预测如何加强手术决策的可能方法。这样一种工具将有助于外科医生优化骨骼未成熟个体的ACL重建，以改善临床结果并降低术后并发症的发生率。
