Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky, USA.
Am J Sports Med. 2021 Mar;49(4):1086-1093. doi: 10.1177/0363546520934774. Epub 2020 Aug 18.
In the skeletally mature anterior cruciate ligament (ACL) reconstruction population, patients aged <25 years are at significantly increased risk of graft failure and injury to the contralateral ACL. Skeletal immaturity often affects graft selection and reconstruction technique.
To examine the incidence of ipsilateral graft failure and contralateral ACL injury in the skeletally immature patient population.
Systematic review and meta-analysis.
Using the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines, we reviewed all literature that involved ACL reconstruction performed on skeletally immature patients between May 1976 and May 2019. Patient demographics, surgical technique, and the prevalence of ipsilateral graft failure or subsequent contralateral ACL injury were recorded. Ipsilateral, contralateral, and secondary ACL injuries were then compared between sexes via chi-square tests.
A total of 24 articles (1254 children; 1258 knees) met inclusion criteria for analysis. Ipsilateral graft failures occurred in 105 of 1258 patients (8.3%), and there were no statistically significant sex differences in the prevalence of graft failures (female, 9.7%; male patients, 7.1%; = .14). The prevalence of contralateral ACL injury was significantly greater in female (29/129; 22.5%) than male (18/206; 8.7%; = .0004) patients in the 9 studies that reported contralateral injury. Skeletally immature female patients were at significantly increased risk of contralateral ACL injury (odds ratio = 3.0; = .0006) when compared with their male counterparts.
In the literature to date, 1 in 3 female skeletally immature patients experienced an ipsilateral graft failure or contralateral ACL injury. Regardless of sex, the 24% prevalence of secondary injury after pediatric ACL reconstruction is almost identical to previously published secondary injury rates in skeletally mature patients <25 years old. As such, skeletal maturity alone does not seem to be a determinant of secondary injury; however, there is a clear need to improve postoperative rehabilitation, activity progression, and return-to-play testing to allow a safe return to sports that protects the long-term health of the reconstructed and contralateral limbs, especially for female patients.
在骨骼成熟的前交叉韧带（ACL）重建人群中，<25 岁的患者发生移植物失败和对侧 ACL 损伤的风险显著增加。骨骼不成熟通常会影响移植物的选择和重建技术。
检查骨骼不成熟患者人群中同侧移植物失败和对侧 ACL 损伤的发生率。
系统评价和荟萃分析。
使用 PRISMA（系统评价和荟萃分析的首选报告项目）指南，我们回顾了 1976 年 5 月至 2019 年 5 月期间对骨骼不成熟患者进行的所有涉及 ACL 重建的文献。记录患者的人口统计学、手术技术以及同侧移植物失败或随后对侧 ACL 损伤的发生率。然后，通过卡方检验比较男女之间的同侧、对侧和继发性 ACL 损伤。
共有 24 篇文章（1254 名儿童；1258 个膝关节）符合分析纳入标准。1258 例患者中有 105 例（8.3%）发生同侧移植物失败，且性别之间移植物失败的发生率无统计学差异（女性，9.7%；男性患者，7.1%；=.14）。在报告对侧损伤的 9 项研究中，女性（29/129；22.5%）对侧 ACL 损伤的发生率明显高于男性（18/206；8.7%；=.0004）。与男性相比，骨骼不成熟的女性患者对侧 ACL 损伤的风险显著增加（比值比=3.0；=.0006）。
在目前的文献中，1/3 的骨骼不成熟女性患者经历了同侧移植物失败或对侧 ACL 损伤。无论性别如何，24%的儿童 ACL 重建后继发性损伤的发生率与以前发表的骨骼不成熟<25 岁患者的继发性损伤率几乎相同。因此，骨骼成熟似乎不是继发性损伤的决定因素；然而，显然需要改进术后康复、活动进展和重返赛场测试，以确保安全重返运动，保护重建和对侧肢体的长期健康，尤其是女性患者。
