Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Knee Surg Sports Traumatol Arthrosc. 2024 Jan;32(1):181-195. doi: 10.1002/ksa.12030. Epub 2024 Jan 4.
To summarise the surgical techniques and clinical outcomes in paediatric and adolescent patients undergoing revision anterior cruciate ligament reconstruction (r-ACLR).
Three databases (MEDLINE, PubMed and EMBASE) were searched from inception to 29 July 2023. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, surgical details, patient-reported outcome measures (PROMs), rates of instability, rupture and return to sport (RTS) were extracted.
Eight studies comprising 706 (711 knees) patients were included (48.7% female). The mean age at r-ACLR was 17.1 years (range: 16.5-18.0). Autografts (67.5%) were more common than allografts (32.2%) in revision, with bone-patellar tendon-bone (BPTB) being the most prevalent autograft source (59.6%). Bone grafts were used in seven patients (4.8% of 146 patients). The most common femoral and tibial fixation techniques were interference screws (37.6% and 38.1%, of 244 patients, respectively). The most common tunnelling strategy was anatomic (69.1% of 236 patients), and meniscus repairs were performed in 39.7% of 256 patients. The re-rupture rate was 13.0% in 293 patients. RTS at the same level or higher was 51.6% in 219 patients. The mean (SD) Lysholm score was 88.1 (12.9) in 78 patients, the mean (SD) Tegner score was 6.0 (1.6) in 78 patients, and the mean (SD) IKDC score was 82.6 (16.0) in 126 patients.
R-ACLR in paediatric and adolescent patients predominantly uses BPTB autografts and interference screw femoral and tibial fixation with concomitant meniscal procedures. Rates of re-rupture and RTS at the same level or higher were 13.0% and 51.6%, respectively. Information from this review can provide orthopaedic surgeons with a comprehensive understanding of the most commonly used operative techniques and their outcomes for revision ACLR in this population.
Level IV.
总结儿童和青少年接受前交叉韧带重建（r-ACLR）翻修手术的技术和临床结果。
从建库到 2023 年 7 月 29 日，在三个数据库（MEDLINE、PubMed 和 EMBASE）中进行了检索。作者遵循 PRISMA 和 R-AMSTAR 指南以及 Cochrane 干预措施系统评价手册。提取了人口统计学、手术细节、患者报告的结果测量（PROMs）、不稳定率、破裂率和重返运动（RTS）的数据。
纳入了 8 项研究，共 706 例（711 膝）患者（48.7%为女性）。r-ACLR 的平均年龄为 17.1 岁（范围：16.5-18.0）。翻修时自体移植物（67.5%）比同种异体移植物（32.2%）更常见，其中骨-髌腱-骨（BPTB）是最常见的自体移植物来源（59.6%）。7 例患者（146 例患者的 4.8%）使用了骨移植物。最常见的股骨和胫骨固定技术是干扰螺钉（分别为 244 例患者的 37.6%和 38.1%）。最常见的隧道策略是解剖学（236 例患者中有 69.1%），256 例患者中有 39.7%进行了半月板修复。293 例患者的再断裂率为 13.0%。219 例患者相同或更高水平的 RTS 为 51.6%。78 例患者的 Lysholm 评分平均（SD）为 88.1（12.9），78 例患者的 Tegner 评分平均（SD）为 6.0（1.6），126 例患者的 IKDC 评分平均（SD）为 82.6（16.0）。
儿童和青少年的 r-ACLR 主要使用 BPTB 自体移植物和干扰螺钉股骨和胫骨固定，并伴有半月板手术。再断裂率和相同或更高水平的 RTS 分别为 13.0%和 51.6%。本综述提供的信息可使矫形外科医生全面了解该人群中 r-ACLR 最常用的手术技术及其结果。
IV 级。
