Wong Stephanie E, Feeley Brian T, Pandya Nirav K
Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, USA.
Orthop J Sports Med. 2019 Mar 28;7(3):2325967119833689. doi: 10.1177/2325967119833689. eCollection 2019 Mar.
A variety of techniques are used for physeal-sparing anterior cruciate ligament (ACL) reconstruction; however, there is no clear consensus on the ideal surgical technique, the frequency of complications, and how to best avoid growth disturbance. The purpose of this study was to compare outcomes and complications between over-the-top and all-epiphyseal ACL reconstruction techniques. The hypothesis was that both physeal-sparing reconstruction techniques are efficacious, with similar risk of growth disturbance and complications. The Embase and PubMed databases were queried for studies on ACL ruptures in the skeletally immature population from 1985 to 2018. Full-text English studies were included (N = 160). Studies reporting rerupture and/or complications after physeal-sparing ACL reconstruction, specifically growth disturbance, were included (n = 10). Studies were separated into 2 groups: an all-epiphyseal group with femoral and tibial fixation points within the epiphysis and a group that had over-the-top femoral and tibial physeal-sparing reconstruction. Complications not specific to the pediatric population were excluded. Demographics, evaluation of skeletal maturity, surgical technique, growth disturbance, rerupture, and patient-reported outcome scores were collected. Data were analyzed in aggregate. The 10 studies included 482 knees. The mean age was 12.0 years; 81% of patients were male; and mean follow-up was 47.7 months. A total of 178 patients underwent all-epiphyseal reconstruction, and 298 had the femoral graft placed over the top. The rerupture rate was 9.0% (16 of 178) in the all-epiphyseal group and 7.2% (14 of 195) in the over-the-top group, of which 82% required revision reconstruction. Six patients had overgrowth in the all-epiphyseal group (mean, 1.8 cm) and 1 patient in the over-the-top group (1.5 cm). Three angular deformities occurred, all of which were in the over-the-top group. Both physeal-sparing ACL reconstruction techniques are successful. Overgrowth was more common in the all-epiphyseal group and angular deformity in the over-the-top group. Rerupture rates were similar between the groups. The authors recommend standardization of skeletal age assessment and baseline lower extremity alignment films.
多种技术被用于保留骺板的前交叉韧带（ACL）重建；然而，对于理想的手术技术、并发症的发生率以及如何最好地避免生长发育障碍，目前尚无明确的共识。本研究的目的是比较经胫骨隧道过顶和全骨骺ACL重建技术的疗效和并发症。假设是两种保留骺板的重建技术都是有效的，生长发育障碍和并发症的风险相似。检索了Embase和PubMed数据库中1985年至2018年关于骨骼未成熟人群ACL断裂的研究。纳入全文为英文的研究（N = 160）。纳入报告保留骺板的ACL重建术后再断裂和/或并发症，特别是生长发育障碍的研究（n = 10）。研究分为两组：全骨骺组，股骨和胫骨固定点位于骨骺内；另一组为经胫骨隧道过顶的股骨和胫骨保留骺板重建。排除非小儿人群特有的并发症。收集人口统计学资料、骨骼成熟度评估、手术技术、生长发育障碍、再断裂情况以及患者报告的结局评分。对数据进行综合分析。10项研究共纳入482例膝关节。平均年龄为12.0岁；81%的患者为男性；平均随访时间为47.7个月。共有178例患者接受了全骨骺重建，298例患者采用了经胫骨隧道过顶的股骨移植。全骨骺组的再断裂率为9.0%（178例中的16例），经胫骨隧道过顶组为7.2%（195例中的14例），其中82%需要翻修重建。全骨骺组有6例出现过度生长（平均1.8 cm），经胫骨隧道过顶组有1例（1.5 cm）。发生了3例角形畸形，均在经胫骨隧道过顶组。两种保留骺板的ACL重建技术都是成功的。过度生长在全骨骺组更常见，角形畸形在经胫骨隧道过顶组更常见。两组的再断裂率相似。作者建议对骨骼年龄评估和下肢基线对线X线片进行标准化。
