Bonasia Davide Edoardo, Amendola Annunziato, Rosso Federica, Rossi Roberto
Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy.
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
Arthrosc Tech. 2024 Feb 14;13(4):102903. doi: 10.1016/j.eats.2023.102903. eCollection 2024 Apr.
In pediatric anterior cruciate ligament reconstruction, many factors should be considered: (1) risk of growth disturbance; (2) high risk of re-tear; (3) determination of the skeletal age, which is sometimes challenging; and (4) no single technique indicated for all patients. The choice of the technique mostly depends on the patients' age and growth potential. Whereas prepubescent patients can be safely treated with physeal sparing techniques (i.e., the Kocher-Micheli technique or its modifications), in postpubescent patients physeal respecting or adult-type reconstructions are generally indicated. In pubescent patients, both all-inside all-epiphyseal and partial transphyseal techniques can be safely performed, but these are not without shortcomings. With the goal of overcoming some of the drawbacks of the existing techniques, the authors describe this technical note. The technique entails an over-the-top femoral position of a 6-strand hamstring graft and an all-epiphyseal tibial tunnel. The femoral physis is completely preserved, and only a 4.5 mm transphyseal tunnel is drilled in the tibia with an all-epiphyseal tibial half socket. With this technique, the graft diameter is adequate, there is no need for fluoroscopy, no risk of graft/tunnel mismatch, and a modified Arnold-Coker lateral tenodesis can be associated via the same lateral incision.
在小儿前交叉韧带重建中，应考虑许多因素：（1）生长发育障碍的风险；（2）再次撕裂的高风险；（3）骨骼年龄的确定，这有时具有挑战性；（4）没有一种技术适用于所有患者。技术的选择主要取决于患者的年龄和生长潜力。青春期前的患者可以安全地采用保留骺板的技术（即Kocher-Micheli技术或其改良技术）进行治疗，而青春期后的患者通常需要采用保留骺板或成人型重建技术。对于青春期患者，全关节内全骨骺和部分经骨骺技术都可以安全地实施，但这些技术并非没有缺点。为了克服现有技术的一些缺点，作者描述了本技术说明。该技术需要将6股绳肌移植物置于股骨的过顶位置，并建立一个全骨骺胫骨隧道。股骨骨骺完全保留，在胫骨上仅钻一个4.5毫米的经骨骺隧道，并使用全骨骺胫骨半套接。采用该技术，移植物直径足够，无需使用荧光透视，不存在移植物/隧道不匹配的风险，并且可以通过相同的外侧切口进行改良的Arnold-Coker外侧腱固定术。
