Bixby Elise C, Heyworth Benton E
Department of Sports Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
Curr Rev Musculoskelet Med. 2024 Jul;17(7):258-272. doi: 10.1007/s12178-024-09897-9. Epub 2024 Apr 19.
Anterior cruciate ligament (ALC) tears are increasingly common in skeletally immature patients, as more children and adolescents participate in intensive sports training and specialization at increasingly younger ages. These injuries were historically treated nonoperatively, given concerns for physeal damage and subsequent growth disturbances after traditional ACL reconstruction techniques. However, there is now sufficient data to suggest superior outcomes with operative treatment, specifically with physeal-sparing and physeal-respecting techniques. This article reviews considerations of skeletal maturity in patients with ACL tears, then discusses surgical techniques, with a focus on their unique indications and outcomes. Additional surgical adjuncts and components of postoperative rehabilitation, which may reduce retear rates, are also considered.
Current research shows favorable patient-reported outcomes and high return-to-sport rates after ACL reconstruction in skeletally immature patients. Graft rupture (ACL retear) rates are low, but notably higher than in most adult populations. Historically, there has been insufficient research to comprehensively compare reconstruction techniques used in this patient population. However, thoughtful systematic reviews and multicenter prospective studies are emerging to address this deficit. Also, more recent data suggests the addition of lateral extra-articular procedures and stringent return-to-sports testing may lower retear rates. Physeal-sparing and physeal-respecting ACL reconstructions result in stabilization of the knee, while respecting the growth remaining in children or skeletally immature adolescents. Future research will be essential to compare these techniques, given that more than one may be appropriate for patients of a specific age and skeletal maturity.
综述目的：随着越来越多的儿童和青少年在越来越小的年龄就开始参加高强度的运动训练和专项运动，前交叉韧带（ACL）撕裂在骨骼未成熟的患者中越来越常见。由于担心传统ACL重建技术会导致骺板损伤及随后的生长紊乱，这些损伤在历史上通常采用非手术治疗。然而，现在有足够的数据表明手术治疗能取得更好的效果，特别是采用保留骺板和尊重骺板的技术。本文回顾了ACL撕裂患者骨骼成熟度的相关考量因素，然后讨论手术技术，重点关注其独特的适应证和治疗效果。还考虑了可能降低再次撕裂率的其他手术辅助手段和术后康复内容。
最新发现：目前的研究表明，骨骼未成熟患者在ACL重建术后的患者报告结局良好，重返运动率高。移植物破裂（ACL再次撕裂）率较低，但明显高于大多数成年人群体。从历史上看，对于该患者群体中使用的重建技术进行全面比较的研究并不充分。然而，正在出现一些经过深思熟虑的系统评价和多中心前瞻性研究来弥补这一不足。此外，最新数据表明，增加外侧关节外手术和严格的重返运动测试可能会降低再次撕裂率。保留骺板和尊重骺板的ACL重建可使膝关节稳定，同时尊重儿童或骨骼未成熟青少年剩余的生长能力。鉴于对于特定年龄和骨骼成熟度的患者，可能不止一种技术适用，未来的研究对于比较这些技术至关重要。
