Service de chirurgie orthopédique pédiatrique, CHU Hautepierre, avenue Molière, 67098 Strasbourg, France; Fédération de médecine translationnelle, faculté de médecine, université de Strasbourg, 67200 Strasbourg, France.
Service de chirurgie orthopédique pédiatrique, hôpital mère-et-enfant, CHU de Nantes, 9, Quai Moncousu, 44000 Nantes, France.
Orthop Traumatol Surg Res. 2018 Dec;104(8S):S175-S181. doi: 10.1016/j.otsr.2018.09.002. Epub 2018 Sep 27.
INTRODUCTION: We were interested in the consequences of anterior cruciate ligament (ACL) reconstruction on the growth plates and the impact on growth in children with open growth plates. The primary objective was related to growth disturbances with the null hypothesis being that ACL reconstruction in open growth plates does not cause any. The secondary objective related to the presence of physis lesions on MRI, with the null hypothesis being that ACL reconstruction in open growth plates does not induce any. MATERIAL AND METHODS: In the context of a 2017 SFA symposium on ACL reconstruction with open growth plates, we conducted a prospective multicenter study with 2 years' follow-up. The study enrolled 100 patients; 71 were available for analysis. Four reconstruction techniques were used: semitendinosus-gracilis (STG), short graft (SG), quadriceps tendon (QT) and fascia lata (FL). MRI was used to look for growth disturbances as evidenced by deviation of the Harris lines or modification of the physis and diaphysis angles. Physis lesions were determined on MRI based on the presence of physeal bone bridges (PBB). RESULTS: No growth disturbances were found. However, PBBs were found in 14 patients (20%). At the femur, the relative risk (RR) was higher when a STG graft was used (RR=2.1) and the tunnel diameter was≥9mm (RR=1.7). Epiphyseal fixation had a higher risk than transphyseal fixation (RR=1.6 vs. 1.2). At the tibia, the RR was higher when a QT graft was used (RR=3.6), when screw fixation was performed (RR=3.7) or when the graft did not fill the tunnel sufficiently (RR=1.5). DISCUSSION: The absence of growth disturbances after 2 years' follow-up validates the possibility of ACL reconstruction with open growth plates, including with transphyseal techniques. The presence of small growth plate lesions such as bone bridges means that precautions should be taken with respect to tunnel trajectory, tunnel diameter, graft and tunnel diameter matching and graft fixation. LEVEL OF EVIDENCE: III, prospective cohort study.
简介：我们对前交叉韧带（ACL）重建对生长板的影响以及对生长板未闭儿童的生长影响感兴趣。主要目标与生长障碍有关，零假设是生长板未闭的 ACL 重建不会造成任何生长障碍。次要目标与 MRI 上的骺板病变有关，零假设是生长板未闭的 ACL 重建不会引起任何骺板病变。
材料和方法：在 2017 年 SFA 关于生长板未闭 ACL 重建的研讨会背景下，我们进行了一项前瞻性多中心研究，随访时间为 2 年。该研究纳入了 100 例患者，其中 71 例可进行分析。使用了 4 种重建技术：半腱肌-股薄肌（STG）、短移植物（SG）、股四头肌肌腱（QT）和阔筋膜（FL）。MRI 用于寻找生长障碍的证据，如 Harris 线的偏离或骺板和骨干角度的改变。骺板病变是根据骺板骨桥（PBB）的存在在 MRI 上确定的。
结果：未发现生长障碍。然而，在 14 例患者（20%）中发现了 PBB。在股骨，当使用 STG 移植物时（RR=2.1）和隧道直径≥9mm 时（RR=1.7），相对风险（RR）更高。骺板固定的风险高于骺板下固定（RR=1.6 比 1.2）。在胫骨，当使用 QT 移植物时（RR=3.6）、当使用螺钉固定时（RR=3.7）或当移植物不能充分填充隧道时（RR=1.5），RR 更高。
讨论：2 年随访后未发现生长障碍，这验证了生长板未闭的 ACL 重建的可能性，包括经骺板技术。小的骺板病变如骨桥的存在意味着应注意隧道轨迹、隧道直径、移植物和隧道直径匹配以及移植物固定。
证据水平：III 级，前瞻性队列研究。
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