小儿患者延迟前交叉韧带重建术后内侧和外侧半月板撕裂的发生率
Incidence of Medial and Lateral Meniscal Tears After Delayed Anterior Cruciate Ligament Reconstruction in Pediatric Patients.
作者信息
Kawashima Itaru, Hiraiwa Hideki, Ishizuka Shinya, Kawai Ryosuke, Kusaka Yoshiaki, Ohtomo Katsuyuki, Tsukahara Takashi
机构信息
Department of Orthopaedic Surgery, Asahi University Hospital, Gifu, Japan.
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
出版信息
Orthop J Sports Med. 2020 Nov 19;8(11):2325967120964603. doi: 10.1177/2325967120964603. eCollection 2020 Nov.
BACKGROUND
The treatment of pediatric anterior cruciate ligament (ACL) injuries is controversial, and no clear management guidelines have been established.
PURPOSE
To evaluate the association between elapsed time from ACL injury to surgery and the incidence of meniscal tears and chondral injuries in patients aged ≤16 years.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
Between December 2012 and April 2019, a total of 207 consecutive knees in 207 patients aged ≤16 years underwent primary ACL reconstruction and were included in this study. Patients were divided into 1 of 2 groups (early group [≤150 days] and delayed group [>150 days]) based on the time between injury and surgery. Patient records, including arthroscopic findings identified by 2 experienced knee surgeons at the time of surgery, were reviewed for demographic information, incidence and types of medial and lateral meniscal tears, and chondral injuries and their locations in each group.
RESULTS
There were 180 knees in the early group and 27 knees in the delayed group. The delayed group showed a significantly higher rate of medial meniscal tears than the early group: 16 of 27 (59.2%) and 46 of 180 (25.6%), respectively (odds ratio [OR], 4.24 [95% CI, 1.83-9.33]; = .0011). The delayed group had a significantly lower rate of lateral meniscal tears than the early group: 6 of 27 (22.2%) and 90 of 180 (50.0%), respectively (OR, 0.29 [95% CI, 0.11-0.70]; = .007). The delayed group had significantly higher rates of chondral injuries in the medial femoral condyle and the medial tibial plateau than the early group: 8 of 27 (29.6%) and 25 of 180 (13.9%), respectively (OR, 2.61 [95% CI, 1.03-6.62]; = .049), and 2 of 27 (7.4%) and 1 of 180 (0.6%), respectively (OR, 14.32 [95% CI, 1.58-208.10]; = .045).
CONCLUSION
Delayed ACL reconstruction was associated with an increased incidence of medial chondral injuries and medial meniscal tears but with a decreased incidence of lateral meniscal tears.
背景
小儿前交叉韧带（ACL）损伤的治疗存在争议，尚未建立明确的管理指南。
目的
评估16岁及以下患者从ACL损伤到手术的时间间隔与半月板撕裂和软骨损伤发生率之间的关联。
研究设计
队列研究；证据等级，3级。
方法
2012年12月至2019年4月期间，207例16岁及以下患者的207个膝关节连续接受了初次ACL重建，并纳入本研究。根据损伤与手术之间的时间，将患者分为2组中的1组（早期组[≤150天]和延迟组[>150天]）。回顾患者记录，包括2名经验丰富的膝关节外科医生在手术时确定的关节镜检查结果，以获取每组的人口统计学信息、内侧和外侧半月板撕裂的发生率和类型、软骨损伤及其位置。
结果
早期组有180个膝关节，延迟组有27个膝关节。延迟组内侧半月板撕裂率明显高于早期组：分别为27例中的16例（59.2%）和180例中的46例（25.6%）（优势比[OR]，4.24[95%CI，1.83 - 9.33]；P = 0.0011）。延迟组外侧半月板撕裂率明显低于早期组：分别为27例中的6例（22.2%）和180例中的90例（50.0%）（OR，0.29[95%CI，0.11 - 0.70]；P = 0.007）。延迟组股骨内侧髁和胫骨内侧平台的软骨损伤率明显高于早期组：分别为27例中的8例（29.6%）和180例中的25例（13.9%）（OR, 2.61[95%CI，1.03 - 6.62]；P = 0.049），以及分别为27例中的2例（7.4%）和180例中的1例（0.6%）（OR，14.32[95%CI，1.58 - 208.10]；P = 0.045）。
结论
延迟ACL重建与内侧软骨损伤和内侧半月板撕裂的发生率增加相关，但与外侧半月板撕裂的发生率降低相关。
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