Christino Melissa A, Tepolt Frances A, Sugimoto Dai, Micheli Lyle J, Kocher Mininder S
Children's Orthopaedics of Atlanta, Atlanta, GA.
Department of Orthopaedic Surgery, Division of Sports Medicine, Boston Children's Hospital.
J Pediatr Orthop. 2020 Mar;40(3):129-134. doi: 10.1097/BPO.0000000000001155.
Revision anterior cruciate ligament (ACL) reconstruction in pediatric patients has not been well studied. The purpose of this study was to assess the demographics, technique, and results of ACL revision surgery in children and adolescents.
This was a retrospective case series with outcomes assessment of patients 18 years old and younger who underwent revision ACL surgery over a 16-year period at a single institution. Medical records were reviewed for demographics, clinical and operative data, and patients were contacted for outcomes at a minimum of 1 year after revision surgery.
Ninety revision ACL reconstructions were performed by 7 surgeons in 88 patients (44 male, 44 female). Average patient age at the time of revision was 16.6 years (SD, 1.7), and 28.8% of patients were skeletally immature. Time to failure after primary ACL reconstruction was 1.28 years (SD, 1.1) and revision surgery was performed 1.56 years (SD, 1) after the index procedure. Revision graft type included allograft (61.1%), patellar tendon (21.1%), hamstring (16.7%), and iliotibial band (1.1%). There was a 20% graft reinjury rate. Subsequent surgical procedures after revision were required in 25.5% of knees. Twenty percent of revision reconstructions had contralateral ACL injuries, and this percentage was higher (33%) among those who went on to injure their revision graft. Median outcome scores collected from 44 patients (50%) at a mean of 5.1 years following surgery (SD, 3.4) were: Pedi-IKDC 79.9, Lysholm 84.5, and Tegner 9.0. Sixty-nine percent of patients reported returning to sports, however, only 55.2% of these reported being able to return to the same level of play.
Revision ACL reconstruction in pediatric patients was associated with suboptimal patient-reported outcomes, high complication rates, relatively high graft retear rates, high risk of contralateral ACL injury, and compromised return to sports rates.
Level IV.
小儿患者前交叉韧带（ACL）翻修重建术尚未得到充分研究。本研究的目的是评估儿童和青少年ACL翻修手术的人口统计学特征、技术及结果。
这是一项回顾性病例系列研究，对一家机构16年间接受ACL翻修手术的18岁及以下患者进行结果评估。查阅病历以获取人口统计学信息、临床和手术数据，并在翻修手术后至少1年与患者联系以了解结果。
7名外科医生为88例患者（44例男性，44例女性）实施了90次ACL翻修重建术。翻修时患者的平均年龄为16.6岁（标准差1.7），28.8%的患者骨骼未成熟。初次ACL重建术后至失败的时间为1.28年（标准差1.1），翻修手术在初次手术后1.56年（标准差1）进行。翻修移植物类型包括同种异体移植物（61.1%）、髌腱（21.1%）、腘绳肌（16.7%）和髂胫束（1.1%）。移植物再损伤率为20%。25.5%的膝关节在翻修后需要进行后续手术。20%的翻修重建患者对侧ACL损伤，在那些翻修移植物受伤的患者中这一比例更高（33%）。术后平均5.1年（标准差3.4）从44例患者（50%）收集的中位结果评分如下：儿童国际膝关节文献委员会（Pedi-IKDC）评分为79.9，Lysholm评分为84.5，Tegner评分为9.0。69%的患者报告恢复运动，然而，其中只有55.2%的患者报告能够恢复到之前的运动水平。
小儿患者ACL翻修重建术与患者报告的结果不理想、并发症发生率高、移植物再撕裂率相对较高、对侧ACL损伤风险高以及恢复运动率受损有关。
四级。
