Foissey Constant, Thaunat Mathieu, Caron Etienne, Haidar Ibrahim, Vieira Thais Dutra, Gomes Lucas, Freychet Benjamin, Sonnery-Cottet Bertrand, Fayard Jean-Marie
Centre Orthopédique Santy, Lyon; and Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.
Arthrosc Sports Med Rehabil. 2022 Oct 9;4(6):e1941-e1951. doi: 10.1016/j.asmr.2022.08.002. eCollection 2022 Dec.
To analyze the rates of graft ruptures and growth disorders, the level of return to sport, and the clinical results of 2 lateral extra-articular procedures in growing children.
This study was a retrospective, single-center study of patients undergoing anterior cruciate ligament (ACL) surgery combined with 2 different lateral extra-articular procedures (anatomic reconstruction with a gracilis graft or modified Lemaire technique with a strip of fascia lata). The measurements of side-to-side anterior laxity and pivot shift were performed preoperatively and at the last follow-up. The sports level and the complications rate were assessed. The minimal clinically important differences (MCID) and patient acceptable symptoms state threshold scores were calculated.
Thirty-nine patients (40 ACLs) were included (20 anatomic and 20 modified Lemaire) at an average follow-up of 57 months ± 10 [42-74]. One patient (2.5%) was lost to follow-up. The mean age at surgery was 13.8 ± 1.4 years old [9.8; 16.5]. One graft failure was reported (2.6% [0.06-13.5]) at 35.6 months after surgery. Two cases (5.4%) of femoral overgrowth were observed, and one of them required distal femoral epiphysiodesis. Ninety-two percent of the patients returned to sports. At the final follow-up, side-to-side anterior laxity was significantly improved, and no residual pivot shift was recorded in 95% of patients. Eighty-nine percent of the patients presented a Pedi-International Knee Documentation Committee score greater than the MCID postoperatively, and 77% presented a Lysholm score greater than the MCID.
This series of ACL reconstructions combined with 2 different lateral extra-articular procedures in skeletally immature patients demonstrated promising findings. The low rate of observed complications, including graft rupture and growth disturbance, is encouraging, but the small study population and lack of comparative group precludes reliable conclusions.
IV, therapeutic case series.
分析生长发育期儿童两种外侧关节外手术的移植物破裂和生长障碍发生率、恢复运动水平及临床结果。
本研究是一项回顾性单中心研究，纳入接受前交叉韧带（ACL）手术并联合两种不同外侧关节外手术（股薄肌移植物解剖重建或阔筋膜条改良勒梅尔技术）的患者。术前及末次随访时进行双侧前向松弛度和轴移测量。评估运动水平和并发症发生率。计算最小临床重要差异（MCID）和患者可接受症状状态阈值评分。
纳入39例患者（40条ACL），平均随访57个月±10[42 - 74]。1例患者（2.5%）失访。手术时平均年龄为13.8±1.4岁[9.8；16.5]。术后35.6个月报告1例移植物失败（2.6%[0.06 - 13.5]）。观察到2例（5.4%）股骨过度生长，其中1例需要股骨远端骨骺阻滞术。92%的患者恢复运动。末次随访时，双侧前向松弛度显著改善，95%的患者未记录到残留轴移。89%的患者术后国际膝关节文献委员会（Pedi - International Knee Documentation Committee）评分高于MCID，77%的患者Lysholm评分高于MCID。
这一系列在骨骼未成熟患者中联合两种不同外侧关节外手术的ACL重建显示出有前景的结果。观察到的包括移植物破裂和生长紊乱在内的并发症发生率较低，令人鼓舞，但研究人群小且缺乏对照组，无法得出可靠结论。
IV，治疗性病例系列。
