O'Brien Adam O, Stokes Julia, Bompadre Viviana, Schmale Gregory A
Department of Orthopedics and Sports Medicine, Seattle Children's Hospital.
Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine, Seattle, WA.
J Pediatr Orthop. 2019 Aug;39(7):e500-e505. doi: 10.1097/BPO.0000000000001330.
Young athletes with an anterior cruciate ligament (ACL) disruption and limb malalignment pose a treatment dilemma. Little has been published regarding limb malalignment in this population. Our aim is to review the results of combined treatment of an ACL deficient knee and genu valgum in skeletally immature patients.
A retrospective review of skeletally immature patients who underwent transphyseal ACL reconstruction and concomitant hemiepiphysiodesis between 2004 and 2015 by 1 surgeon at a single institution was performed. Included patients had at least a year of growth remaining and were followed to skeletal maturity. Patients with a diagnosis of a connective tissue disorder were excluded. Knee stability, rate of retear, the rate of mechanical axis correction, and time to full correction were determined.
Ninety skeletally immature patients underwent transphyseal ACL reconstruction, 8 of which met inclusion criteria. Mean time to correction of the valgus deformity was 13 months (0.4 degree/mo). No patient required additional surgeries for malalignment. All patients had improvement in knee stability. One patient had a retear of their ACL reconstruction, for a failure rate of 13%. Preoperative mechanical lateral distal femoral angle and mechanical axis deviation corrected to near-neutral alignment for all treated limbs and were significantly different (P=0.001) than those measured preoperatively.
Promising results were seen for simultaneous correction of genu valgum and transphyseal ACL reconstruction. Treatment of both pathologies in a concomitant surgery can be considered in the appropriate population, with expected results comparable to each procedure in isolation.
Level IV-case series.
患有前交叉韧带（ACL）断裂和肢体排列不齐的年轻运动员面临治疗困境。关于该人群肢体排列不齐的报道较少。我们的目的是回顾骨骼未成熟患者ACL缺失膝关节合并膝外翻的联合治疗结果。
对2004年至2015年间在单一机构由1名外科医生进行经骨骺ACL重建及同期半骨骺阻滞术的骨骼未成熟患者进行回顾性研究。纳入患者至少还有一年的生长时间，并随访至骨骼成熟。排除诊断为结缔组织疾病的患者。确定膝关节稳定性、再撕裂率、机械轴矫正率和完全矫正时间。
90例骨骼未成熟患者接受了经骨骺ACL重建，其中8例符合纳入标准。膝外翻畸形矫正的平均时间为13个月（0.4度/月）。没有患者因排列不齐需要额外手术。所有患者膝关节稳定性均有改善。1例患者ACL重建出现再撕裂，失败率为13%。所有治疗肢体的术前机械性股骨远端外侧角和机械轴偏差均矫正至接近中立对线，且与术前测量值有显著差异（P=0.001）。
同时矫正膝外翻和经骨骺ACL重建取得了有前景的结果。对于合适的人群，可以考虑在同一手术中治疗这两种病变，预期结果与单独进行每种手术相当。
IV级——病例系列。
