Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
J ISAKOS. 2023 Jun;8(3):184-188. doi: 10.1016/j.jisako.2023.03.003. Epub 2023 Mar 17.
Adolescents with anterior cruciate ligament (ACL) tears can present with concomitant lower extremity coronal plane angular deformity (CPAD) that both predispose to injury as well as may increase the risk of graft rupture following ACL reconstruction (ACLR). The goal of this study was to examine the safety and efficacy of concomitant ACLR with implant-mediated guided growth (IMGG) compared to isolated IMGG procedures in paediatric and adolescent patients.
Operative records of all paediatric and adolescent patients (age ≤ 18 years) that underwent simultaneous ACLR and IMGG by one of two paediatric orthopaedic surgeons between 2015 and 2021 were retrospectively reviewed. A comparison cohort of isolated IMGG patients was identified and matched based on bone age within one year, sex, laterality, and fixation type (i.e. transphyseal screw vs. tension band plate and screw construct). Pre- and post-operative mechanical axis deviation (MAD), angular axis deviation (AAD), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA) were recorded.
A total of 9 participants who underwent concomitant ACLR and IMGG (ACLR + IMGG) were identified, with 7 of these participants meeting the final inclusion criteria. The participants had a median age of 12.7 (IQR = 12.1 - 14.2) years and median bone age of 13.0 (IQR = 12.0 - 14.0) years. Of the 7 participants that underwent ACLR and IMGG, 3 underwent a modified MacIntosh procedure with ITB autograft, 2 received quadriceps tendon autograft, and 1 underwent hamstring autograft reconstruction. There were no significant differences in the amount of correction obtained between ACLR + IMGG and matched IMGG subjects with respect to any measurement variable (MAD difference: p = 0.47, AAD difference: p = 0.58, LDFA difference: p = 0.27, MPTA difference: p = 0.20). There were also no significant differences in alignment variables per unit time between cohorts (MAD/month: p = 0.62, AAD/month = 0.80, LDFA/month = 0.27, MPTA/month = 0.20).
The results of the current study indicate that concomitant ACLR and lower extremity CPAD correction is a safe approach to treat CPAD concomitantly with ACLR in young patients who present with an acute ACL tear. Furthermore, one can expect reliable correction of CPAD after combined ACLR and IMGG, no different than the correction obtained in the setting of IMGG alone.
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前交叉韧带（ACL）撕裂的青少年可能会出现下肢冠状面角度畸形（CPAD），这既容易导致受伤，也可能增加 ACL 重建（ACLR）后移植物破裂的风险。本研究的目的是检查同时进行 ACLR 和植入物介导的引导生长（IMGG）与单独进行 IMGG 手术在儿科和青少年患者中的安全性和有效性。
回顾 2015 年至 2021 年间，两位小儿矫形外科医生对所有接受 ACLR 和 IMGG 的儿科和青少年患者（年龄≤18 岁）的手术记录进行了回顾性分析。根据骨龄、性别、侧别和固定类型（即经骺板螺钉与张力带钢板和螺钉结构），确定了单独进行 IMGG 的患者的对照队列，并进行了匹配。记录术前和术后机械轴偏差（MAD）、角轴偏差（AAD）、外侧远端股骨角（LDFA）和内侧近端胫骨角（MPTA）。
共确定了 9 名同时接受 ACLR 和 IMGG（ACLR+IMGG）的患者，其中 7 名符合最终纳入标准。这些患者的中位年龄为 12.7（IQR=12.1-14.2）岁，中位骨龄为 13.0（IQR=12.0-14.0）岁。在接受 ACLR 和 IMGG 的 7 名患者中，3 名患者接受了改良 MacIntosh 手术，使用 ITB 自体移植物，2 名患者接受了股四头肌肌腱自体移植物，1 名患者接受了腘绳肌自体重建。在任何测量变量方面，ACLR+IMGG 和匹配的 IMGG 患者之间的矫正量均无显著差异（MAD 差异：p=0.47，AAD 差异：p=0.58，LDFA 差异：p=0.27，MPTA 差异：p=0.20）。两组队列的单位时间对线变量也无显著差异（MAD/月：p=0.62，AAD/月：p=0.80，LDFA/月：p=0.27，MPTA/月：p=0.20）。
本研究结果表明，同时进行 ACLR 和下肢 CPAD 矫正，对于急性 ACL 撕裂的年轻患者同时治疗 CPAD 和 ACLR 是一种安全的方法。此外，在接受 ACLR 和 IMGG 联合治疗后，可以可靠地矫正 CPAD，与单独进行 IMGG 治疗获得的矫正效果无差异。
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