Sasaki Shizuka, Sasaki Eiji, Kimura Yuka, Yamamoto Yuji, Tsuda Eiichi, Ishibashi Yasuyuki
Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.
Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.
Orthop J Sports Med. 2021 Nov 10;9(11):23259671211051308. doi: 10.1177/23259671211051308. eCollection 2021 Nov.
The treatment strategy for pediatric anterior cruciate ligament (ACL) tears, especially in patients with open physes, remains controversial.
To assess clinical outcomes and postoperative complications after all-epiphyseal double-bundle ACL (DB-ACL) reconstruction for patients with open physes.
Cohort study; Level of evidence, 3.
Included were 102 patients aged ≤15 years who underwent ACL reconstruction at a single institution and had a minimum of 2 years of follow-up. Of these patients, 18 had undergone all-epiphyseal DB-ACL reconstruction (mean age, 12.4 ± 1.2 year) and 84 had undergone conventional DB-ACL reconstruction (mean age, 14.1 ± 0.9 year). The outcomes of the all-epiphyseal group were compared with those of the conventional group. Objective clinical outcomes included KT-1000 arthrometer measurements of side-to-side difference in anterior tibial translation, Lachman test grade, and pivot-shift test grade. Radiographic angular deformity (defined as >3° of the side-to-side difference in femorotibial angle) and incidence of second ACL injury were also compared.
The postoperative side-to-side difference in laxity significantly improved from 6.1 ± 2.4 to 0.6 ± 0.9 mm in the all-epiphyseal group ( = .001), and postoperative laxity was similar to that of the conventional group (0.4 ± 0.8 mm; = .518). A Lachman grade 1 positive result was observed in 20% of the all-epiphyseal group and 3% of the conventional group ( = .042), and a pivot-shift grade 1 positive result was observed in 22% of the all-epiphyseal group and 4% of the conventional group ( = .074). A total of 4 patients (26.7%) in the all-epiphyseal group and 4 (6.1%) in the conventional group demonstrated angular deformity ( = .035). The incidence of postoperative ipsilateral ACL tear was 16.7% in the all-epiphyseal group and 23.8% in the conventional group ( = .757). The incidence of contralateral ACL tear was 11.1% in the all-epiphyseal group and 14.3% in the conventional group ( ≥ .999).
All-epiphyseal DB-ACL reconstruction for skeletally immature patients achieved satisfactory clinical outcomes compared with conventional DB-ACL reconstruction. The incidence of ipsilateral graft rupture was relatively high in both groups. The all-epiphyseal group had a significantly higher incidence of angular deformity.
小儿前交叉韧带（ACL）撕裂的治疗策略，尤其是对于骨骺未闭的患者，仍存在争议。
评估骨骺未闭患者全骨骺双束ACL（DB-ACL）重建后的临床疗效及术后并发症。
队列研究；证据等级，3级。
纳入102例年龄≤15岁、在单一机构接受ACL重建且至少随访2年的患者。其中，18例接受了全骨骺DB-ACL重建（平均年龄12.4±1.2岁），84例接受了传统DB-ACL重建（平均年龄14.1±0.9岁）。将全骨骺组的结果与传统组进行比较。客观临床疗效包括用KT-1000关节测量仪测量胫骨前移的侧方差异、Lachman试验分级和轴移试验分级。还比较了影像学角度畸形（定义为股骨胫骨角侧方差异>3°）和第二次ACL损伤的发生率。
全骨骺组术后松弛度的侧方差异从6.1±2.4mm显著改善至0.6±0.9mm（P=.001），术后松弛度与传统组相似（0.4±0.8mm；P=.518）。全骨骺组20%的患者Lachman试验为1级阳性，传统组为3%（P=.042）；全骨骺组22%的患者轴移试验为1级阳性，传统组为4%（P=.074）。全骨骺组共有4例患者（26.7%）出现角度畸形表现，传统组有4例（6.1%）（P=.035）。全骨骺组术后同侧ACL撕裂的发生率为16.7%，传统组为23.8%（P=.757）。全骨骺组对侧ACL撕裂的发生率为11.1%，传统组为14.3%（P≥.999）。
与传统DB-ACL重建相比，为骨骼未成熟患者进行全骨骺DB-ACL重建取得了满意的临床疗效。两组同侧移植物破裂的发生率相对较高。全骨骺组角度畸形的发生率显著更高。
