Faunø Peter Ziegler, Bøge Steinmeier Larsen Jannie, Nielsen Mette Mølby, Hellfritzsch Michel, Nielsen Torsten Grønbech, Lind Martin
Department of Sports Medicine, Aarhus University Hospital, Aarhus, Denmark.
Arthrosc Sports Med Rehabil. 2023 Sep 29;5(6):100793. doi: 10.1016/j.asmr.2023.100793. eCollection 2023 Dec.
To evaluate radiological tibial and femoral length and axis growth disturbances, as well as clinical outcome in skeletal immature anterior cruciate ligament reconstruction (ACLR) patients treated with a femoral growth plate-sparing ACLR technique.
Skeletally immature patients who underwent operation between 2013 to 2019 with ALCR using the femoral growth plate-sparing technique were investigated with follow-up after growth plate closure. The inclusion criteria were isolated ACL rupture in patients with open physis in the distal femur and proximal tibia seen at plain radiography. The minimum follow-up time was 29 months. Patients were evaluated with full extremity radiographs measuring limb length discrepancy and coronal knee alignment compared to contralateral leg, as well as clinical evaluation with Rolimeter measurements and the Knee Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee subjective knee form (IKDC), and Tegner Activity Scale scores.
Sixty-five patients were examined with radiography, and 52 patients were assessed with clinical examination The mean follow-up time was 68 (range, 29-148) months. No limb-length discrepancy (-0.65 mm [confidence interval {CI}, -2.21 to 0.92]) or angular deformity at tibia (-0.25° [CI, -0.78° to 0.28°]) was found. There was a small but statistically significant different angular deformity at the distal femur compared to the contralateral leg (-1.51° [CI, -2.31 to -0.72]) at follow-up. The side-to-side difference in knee laxity at follow-up was 2.4 mm. At follow-up the KOOS Sport, KOOS Quality of Life (QoL), IKDC, and Tegner scores were 80, 75, 86, and 5, respectively. Sixty-seven percent of the patients met the Patient Acceptable Symptom State, and 52% reported results exceeding the KOOS Sport MCID Level and 69% the KOOS QoL level.
Femoral physis-sparing ALCR is associated with a low risk of alignment and length disturbances. The technique provides otherwise good subjective clinical outcome and knee stability.
Level IV, therapeutic case series.
评估采用保留股骨生长板的前交叉韧带重建（ACLR）技术治疗的骨骼未成熟患者的胫骨和股骨长度及轴线的放射学生长紊乱情况，以及临床疗效。
对2013年至2019年间采用保留股骨生长板技术行ALCR手术的骨骼未成熟患者在生长板闭合后进行随访研究。纳入标准为X线平片显示股骨远端和胫骨近端骨骺开放的单纯前交叉韧带断裂患者。最短随访时间为29个月。对患者进行全下肢X线片检查，测量与对侧肢体相比的肢体长度差异和膝关节冠状位对线情况，并通过Rolimeter测量以及膝关节骨关节炎结局评分（KOOS）、国际膝关节文献委员会主观膝关节评分（IKDC）和Tegner活动量表评分进行临床评估。
65例患者接受了X线检查，52例患者接受了临床检查。平均随访时间为68（范围29 - 148）个月。未发现肢体长度差异（-0.65 mm [置信区间{CI}，-2.21至0.92]）或胫骨角畸形（-0.25° [CI，-0.78°至0.28°]）。随访时与对侧相比，股骨远端存在小但具有统计学意义的角畸形差异（-1.51° [CI，-2.31至-0.72]）。随访时膝关节松弛度的左右差异为2.4 mm。随访时KOOS运动、KOOS生活质量（QoL）、IKDC和Tegner评分分别为80、75、86和5。67%的患者达到患者可接受症状状态，52%的患者报告结果超过KOOS运动最小临床重要差异水平，69%的患者超过KOOS QoL水平。
保留股骨骨骺的ALCR与对线和长度紊乱的低风险相关。该技术在其他方面提供了良好的主观临床疗效和膝关节稳定性。
IV级，治疗性病例系列。
