Department of Orthopaedics, Wake Forest Medical Center, Watlington Hall, 4th Floor, 1 Medical Center Boulevard Winston Salem, Winston-Salem, NC, 27157, US.
Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, 500 University Dr., 414 Hallmark South, Hershey, PA, 17033, USA.
Eur J Orthop Surg Traumatol. 2022 May;32(4):739-744. doi: 10.1007/s00590-021-03032-x. Epub 2021 Jun 10.
Multiple graft options exist for anterior cruciate ligament (ACL) reconstruction in an adolescent athlete. Patellar tendon harvest can lead to anterior knee pain, while hamstring tendon harvest can affect knee flexion strength and alter mechanics. Allograft is less desirable in pediatric patients due to the higher failure rate and slight risk of disease transmission. Quadriceps tendon autograft has rarely been reported for adolescent ACL reconstruction in the USA, but is an excellent option due to its large size, low donor site morbidity, and versatility. The purpose of this study is to report the outcomes of adolescents who have undergone ACL reconstruction using quadriceps tendon autograft.
Twenty-two ACL reconstructions using the quadriceps autograft were performed on 21 pediatric patients by the senior author between 2010 and 2017. The patient's demographics, injury characteristics, imaging, physical examination findings, operative findings, outcomes and sports were recorded.
The average age at the time of surgery was 15 years. Two patients had open physes; the remainder had closing physes. 64% of patients had additional meniscal tears and 76% had bony contusions. The average duration of follow-up was 2.8 years (range 2-5 years). At final follow-up, there were no angular deformities or leg length discrepancies. The average quadriceps atrophy of the operative leg was 4 mm. The average Lysholm score was 98. 86% of patients returned to sports. No patients had re-rupture of their operative ACL. No incidences of infections, numbness, or anterior knee pain were reported. Two patients had a second arthroscopy for re-injury, revealing new meniscal tears but intact ACL grafts.
Use of quadriceps tendon autograft for ACL reconstruction in adolescent patients allows reliable return to sport with minimal complications.
Level IV, retrospective case series.
对于青少年运动员的前交叉韧带（ACL）重建，有多种移植物选择。髌腱采集可能导致前膝疼痛，而腘绳肌腱采集可能影响膝关节屈曲力量并改变力学。同种异体移植物在儿科患者中不太理想，因为失败率较高且有轻微的疾病传播风险。股四头肌肌腱自体移植物在美国很少用于青少年 ACL 重建，但由于其体积大、供体部位发病率低且多功能性，是一个极好的选择。本研究的目的是报告接受股四头肌肌腱自体移植物重建 ACL 的青少年患者的结果。
2010 年至 2017 年，高级作者对 21 名儿科患者进行了 22 例 ACL 重建，均采用股四头肌自体移植物。记录患者的人口统计学、损伤特征、影像学、体格检查结果、手术结果、结果和运动情况。
手术时的平均年龄为 15 岁。有 2 例患者的骺板未闭，其余患者的骺板均已闭合。64%的患者有半月板撕裂，76%的患者有骨挫伤。平均随访时间为 2.8 年（2-5 年）。最终随访时，无角度畸形或肢体长度差异。手术腿的股四头肌平均萎缩 4 毫米。平均 Lysholm 评分为 98 分。86%的患者重返运动。没有患者出现手术 ACL 再断裂。无感染、麻木或前膝疼痛报告。有 2 例患者因再受伤进行了第二次关节镜检查，显示新的半月板撕裂，但 ACL 移植物完整。
在青少年患者中使用股四头肌肌腱自体移植物进行 ACL 重建可可靠地恢复运动，并发症最小。
IV 级，回顾性病例系列。
