McCarroll J R, Rettig A C, Shelbourne K D
Methodist Sports Medicine Center, Indianapolis, Indiana.
Am J Sports Med. 1988 Jan-Feb;16(1):44-7. doi: 10.1177/036354658801600107.
From 1980 to 1985, 40 patients under the age of 14 with open physes were treated for midsubstance tears of the ACL at the Methodist Sports Medicine Center. In this series, 16 were treated conservatively with rehabilitation, bracing, and counseling on activity modification. The remaining 24 patients underwent arthroscopic examination and either an extraarticular or intraarticular reconstruction based on growth potential. The average followup was 27 months for the conservative group and 26 months for the surgical group. In the conservative group, six patients underwent arthroscopy for meniscal tears, four medial and two lateral. Only seven patients returned to sports, all experiencing recurrent episodes of giving way, effusions, and pain. In the surgical group, 12 medial and 6 lateral meniscal tears were found at arthroscopy. There were 10 extraarticular reconstructions and 14 intraarticular reconstructions. All 24 returned to sports activity, and 22 of the 24 are still competing. The two remaining patients both suffered reinjury 3 years after their surgery. We recommend arthroscopy and examination under anesthesia for the young patient with ACL tears. Based on the amount of instability, presence or absence of meniscal tears, and athletic desires of the patient and his or her family, a treatment plan can be undertaken.
1980年至1985年期间，卫理公会运动医学中心对40名14岁以下存在开放骨骺的患者进行了前交叉韧带中段撕裂的治疗。在这一系列病例中，16例采用康复、支具固定及活动调整咨询等保守治疗。其余24例患者根据生长潜力接受了关节镜检查及关节外或关节内重建手术。保守治疗组的平均随访时间为27个月，手术治疗组为26个月。保守治疗组中，6例患者因半月板撕裂接受了关节镜检查，其中4例为内侧半月板撕裂，2例为外侧半月板撕裂。只有7例患者恢复了运动，但均出现反复的打软腿、积液和疼痛症状。手术治疗组在关节镜检查时发现12例内侧半月板撕裂和6例外侧半月板撕裂。进行了10例关节外重建和14例关节内重建。24例患者均恢复了体育活动，其中24例中有22例仍在参加比赛。其余2例患者均在术后3年再次受伤。对于患有前交叉韧带撕裂的年轻患者，我们建议在麻醉下进行关节镜检查和评估。根据不稳定程度、半月板撕裂的有无以及患者及其家属的运动意愿，可以制定治疗方案。
