From the The Children's Hospital of Philadelphia, Philadelphia, PA.
J Am Acad Orthop Surg. 2019 Aug 15;27(16):e752-e757. doi: 10.5435/JAAOS-D-18-00276.
Complication rates after physeal-sparing anterior cruciate ligament reconstruction (ACLR) are known to be high in the paediatric population compared with the adult population. However, the outcomes of these skeletally immature patients after all-epiphyseal reconstruction have not been compared with those after transphyseal reconstructions in a more similar age group. This study compares clinical outcomes and complications between all-epiphyseal and pediatric transphyseal ACLR.
We retrospectively reviewed 1,056 pediatric patients undergoing primary ACLR between 2000 and 2015. Of these, 51 were excluded (5 extra-articular and 46 partial transphyseal reconstructions). Demographic data, intraoperative findings and techniques, postoperative complications (including graft rupture, contralateral anterior cruciate ligament [ACL] tear, and meniscus injuries), clearance for sports, range of motion (ROM), and isokinetic strength testing were recorded. Univariate analysis was followed by stepwise, binary logistic regressions to control for confounding factors.
During the study period, 162 patients underwent all-epiphyseal reconstruction (mean age, 12.1 ± 1.8 years) and 843 underwent transphyseal ACLR (mean age, 15.8 ± 1.9 years). At the time of surgery, more meniscus tears were found in the transphyseal group (76% versus 60%; P < 0.01). These patients also had more irreparable meniscus tears requiring partial meniscectomy (35% versus 18%; P < 0.01). Overall, the rates of graft failure, contralateral ACL injury, and new meniscus tears were 10.3%, 6.1%, and 14.2%, respectively. After controlling for confounders in a multivariate model, no difference was found in these postoperative complications between all-epiphyseal and transphyseal ACLR. Furthermore, no clinically significant difference was observed in postoperative ROM or isokinetic strength testing.
Skeletally immature patients undergoing all-epiphyseal ACLR had less irreparable meniscus tears than older children undergoing transphyseal reconstruction. After adjusting for age and other confounders, there was no difference in postoperative ROM or strength, nor an increased risk of graft rupture, contralateral ACL injury, or new meniscus tear in these young patients compared with older adolescents undergoing transphyseal ACLR.
Level III.
与成人相比，儿童人群行骺板保存型前交叉韧带重建（ACLR）后发生并发症的比率较高。然而，对于这些骺板未闭患者，全骺板重建与类似年龄组的经骺板重建后的结果尚未进行比较。本研究比较了全骺板和儿童经骺板 ACLR 的临床结果和并发症。
我们回顾性分析了 2000 年至 2015 年间接受初次 ACLR 的 1056 例儿科患者。其中 51 例被排除（5 例关节外和 46 例部分经骺板重建）。记录人口统计学数据、术中发现和技术、术后并发症（包括移植物破裂、对侧前交叉韧带[ACL]撕裂和半月板损伤）、运动许可、活动范围（ROM）和等速力量测试。进行单变量分析，然后进行逐步二元逻辑回归以控制混杂因素。
在研究期间，162 例患者行全骺板重建（平均年龄 12.1±1.8 岁），843 例患者行经骺板 ACLR（平均年龄 15.8±1.9 岁）。在手术时，经骺板组发现更多的半月板撕裂（76%比 60%；P＜0.01）。这些患者也有更多的不可修复的半月板撕裂，需要行半月板部分切除术（35%比 18%；P＜0.01）。总体而言，移植物失败、对侧 ACL 损伤和新半月板撕裂的发生率分别为 10.3%、6.1%和 14.2%。在多变量模型中控制混杂因素后，全骺板和经骺板 ACLR 之间在这些术后并发症方面没有差异。此外，术后 ROM 或等速力量测试也没有明显的临床差异。
行全骺板 ACLR 的骺板未闭患者比行经骺板重建的大龄儿童的不可修复性半月板撕裂更少。在调整年龄和其他混杂因素后，与大龄青少年经骺板 ACLR 相比，这些年轻患者的术后 ROM 或强度没有差异，移植物破裂、对侧 ACL 损伤或新半月板撕裂的风险也没有增加。
III 级。
