Basingstoke Knee Unit, Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, UK.
Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, Connecticut, USA.
Knee Surg Sports Traumatol Arthrosc. 2020 Aug;28(8):2551-2556. doi: 10.1007/s00167-020-05872-2. Epub 2020 Feb 10.
Anterior cruciate ligament (ACL) surgery in the paediatric population has long been a challenge. Non-operative treatment will result in persistent instability which can lead to chondral and meniscal injuries. The results of primary open ACL repair are poor. Concerns of growth plate disturbance with transphyseal techniques and issues with relatively small-diameter grafts in Tanner 1 and 2 patients, which are inadequate, have contributed to these challenges. With advancing instrumentation, there is renewed interest in ACL repair. The minimally invasive approach of arthroscopic primary ACL repair retains the native ligament. The objective and subjective outcomes at 2 years are presented.
Paediatric patients, less than 16 years of age, presenting acutely with complete proximal ACL ruptures underwent direct arthroscopic ACL repair, reinforced by a temporary internal brace, which was subsequently removed after 3 months. Patient-reported outcome measures including the Lysholm, Tegner and KOOS scores were collected at 6 months, 1 year and 2 years post-operatively.
Twenty patients (age 6-16) completed data at 2 years post-operatively. There were no failures, no complications and no growth disturbance out to 2 years. The 2-year postoperative outcomes; Lysholm 95 (90-100), Tegner 7 (6-10), KOOS-Child 96.5 (88.9-100) demonstrated statistically significant improvements following surgery (p < 0.001). Objective measurements with an accelerometer did not demonstrate any significant side-to-side difference.
ACL repair for proximal ACL tears in the paediatric population demonstrates the potential for excellent outcomes at short-term follow-up. This presents an attractive alternative to ACL reconstruction when an adequate ACL remnant permits direct repair. Our results demonstrate that paediatric ACL repair is safe and effective.
儿童前交叉韧带（ACL）手术一直是一个挑战。非手术治疗会导致持续不稳定，从而导致软骨和半月板损伤。初次开放性 ACL 修复的结果不佳。对于经骺板技术和 Tanner 1 和 2 期患者相对较小直径移植物的问题，存在生长板干扰的担忧以及较小直径移植物的问题，这些问题导致了这些挑战。随着先进仪器的出现，对 ACL 修复的兴趣重新燃起。关节镜下初次 ACL 修复的微创方法保留了原生韧带。目前提出了 2 年的客观和主观结果。
患有急性完全性 ACL 近端撕裂的小于 16 岁的儿科患者接受直接关节镜 ACL 修复，并辅以临时内置支撑物，3 个月后将其取出。术后 6 个月、1 年和 2 年收集患者报告的结果测量指标，包括 Lysholm、Tegner 和 KOOS 评分。
20 例患者（年龄 6-16 岁）在术后 2 年完成了数据收集。2 年内无失败、无并发症和生长障碍。术后 2 年的结果；Lysholm 95（90-100）、Tegner 7（6-10）、KOOS-儿童 96.5（88.9-100）在手术后均显示出统计学显著改善（p<0.001）。使用加速度计进行的客观测量未显示出任何明显的侧间差异。
在儿童人群中，ACL 修复近端 ACL 撕裂在短期随访中显示出良好的结果潜力。当 ACL 残端允许直接修复时，这为 ACL 重建提供了一种有吸引力的替代方案。我们的结果表明，儿童 ACL 修复是安全有效的。
