关节镜下 ACL 重建和胫骨隧道成形术治疗胫骨髁间前嵴撕脱骨折：儿童患者的客观和主观临床结果。

Arthroscopic suture-fixation of anterior tibial intercondylar eminence fractures by retensioning of the ACL and hollowing of the tibial footprint: Objective and subjective clinical results in a paediatric population.

机构信息

Service de chirurgie orthopédique infantile, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France.

Santé Atlantique, avenue Claude-Bernard, 44800 Saint-Herblain, France.

出版信息

Orthop Traumatol Surg Res. 2022 Oct;108(6):103270. doi: 10.1016/j.otsr.2022.103270. Epub 2022 Mar 11.

DOI:10.1016/j.otsr.2022.103270

PMID:35288325

Abstract

INTRODUCTION

Anterior tibial intercondylar eminence fractures (ATIEF) of the knee are rare in children. They are associated with prefracture intraligamental distention of the anterior cruciate ligament (ACL).

OBJECTIVE

The objective of this study was to evaluate the subjective and objective clinical results of an arthroscopic surgical technique by suture-fixation of the fracture and tensioning of the ACL through hollowing of the tibial footprint.

HYPOTHESIS

Suture-tensioning of ATIEF arthroscopically helps to achieve treatment objectives by leaving the knee joint free of any hardware.

MATERIALS AND METHODS

This single-operator monocentric retrospective study involved twenty children operated on over a period of 2-years and 10 months, from March 2013, and with a minimum of one-year follow-up. Surgery was indicated for Stage II to IV fractures according to the Meyers and McKeever classification. Type I fractures were excluded. Seventeen out of 20 patients were reviewed. The median age was 12 years at the time of surgery and the mean follow-up was 28 months. The fractures were 5 of stage II, 9 of III and 3 of IV. The scores of Lysholm, objective and subjective IKDC were collected. Residual objective laxity was measured using the GNRB arthrometer at 150N. A standard X-ray evaluation permitted detection of possible growth disorders.

RESULTS

At 28 months of mean follow-up, the mean scores of Lysholm and subjective IKDC were 99 (95; 100) and 97 (92; 100), respectively. As for the objective IKDC, 14 knees were rated A and 3 were rated B. The mean differential residual laxity via GNRB was 0.94mm (0; 2.4). No radiological growth disorder was observed at the last follow-up.

CONCLUSION

The ACL suture-tensioning technique is simple and reliable. It also preserves the joint of the adult to remain free of any residual hardware.

LEVEL OF EVIDENCE

IV; retrospective cohort study.

摘要

简介

儿童膝关节前胫骨间隆突骨折（ATIEF）较为罕见，常伴有前交叉韧带（ACL）的预骨折性韧带内扩张。

目的

本研究旨在评估通过关节镜下骨折缝合固定和通过胫骨附着点空心化对 ACL 进行张力固定的手术技术的主观和客观临床效果。

假设

关节镜下对 ATIEF 进行缝合张力固定有助于实现治疗目标，同时使膝关节无任何内置物。

材料与方法

本单操作医生单中心回顾性研究共纳入 2013 年 3 月至 2015 年 10 月期间接受手术的 20 例儿童患者，随访时间至少 1 年。根据 Meyers 和 McKeever 分类，对 II 期至 IV 期骨折进行手术治疗。排除 I 型骨折。20 例患者中有 17 例进行了回顾。手术时的中位年龄为 12 岁，平均随访时间为 28 个月。骨折类型 II 期 5 例，III 期 9 例，IV 期 3 例。收集 Lysholm、客观和主观 IKDC 评分。使用 GNRB 关节测量仪在 150N 下测量残余客观松弛度。标准 X 射线评估可检测到可能的生长障碍。