Accadbled Franck, Lescot Timothé, Nicolaou Nicolas, Doumerc Jeremy, Cavaignac Etienne, Flumian Clara, Maupoint Estelle, Sales de Gauzy Jérôme
Department of Orthopaedics, Hôpital des Enfants.
Sport Pro Santé Research, Toulouse, France.
J Pediatr Orthop. 2025;45(5):281-286. doi: 10.1097/BPO.0000000000002888. Epub 2025 Jan 14.
The failure rate of anterior cruciate ligament (ACL) reconstruction in children and adolescents is a significant concern. Of the multitude of clinical factors that contribute to this risk, delayed maturation and graft laxity are potentially related and modifiable elements. The aim was to investigate knee anterior laxity and graft maturation in children and adolescents. The ligamentization of the graft may be correlated with the residual laxity.
A single-center prospective study included skeletally immature patients treated with transphyseal ACL reconstruction using semitendinosus tendon autograft from 2017 to 2019. Participants were evaluated on 4 occasions: preoperatively, then at 6, 12, and 24 months with instrumented laximetry and MRI to analyze graft maturation according to the Signal-to-noise Quotient (SNQ) and Howell classification.
A total of 50 patients (33 boys and 17 girls), with a mean age of 13.2 years (range, 9 to 16) at the time of surgery, were included. Mean side-to-side knee anterior laxity decreased from 2.78 mm preoperatively to 1.59, 1.80, and 1.30 mm (at 6, 12, and 24 mo follow-up, respectively), P <0.05. No statistical difference was noted according to the follow-up or sex. SNQ was unchanged between 6 and 12 months, but a significant difference was demonstrated between 12 months and 24 months ( P =0.008). There was no statistical correlation between laximetry and graft maturation.
ACL graft ligamentization is delayed in children and adolescents and only occurs between 12 and 24 months postoperatively. Residual laximetry and MRI signal of the graft may become one of the multiple elements upon which to base the decision to return to sport.
儿童和青少年前交叉韧带（ACL）重建的失败率是一个重大问题。在众多导致这种风险的临床因素中，发育延迟和移植物松弛是潜在相关且可改变的因素。目的是研究儿童和青少年膝关节前侧松弛及移植物成熟情况。移植物的韧带化可能与残余松弛相关。
一项单中心前瞻性研究纳入了2017年至2019年接受经骨骺ACL重建并用半腱肌腱自体移植物治疗的骨骼未成熟患者。对参与者进行4次评估：术前，然后在术后6、12和24个月采用仪器测量松弛度并进行MRI检查，以根据信噪比（SNQ）和豪厄尔分类法分析移植物成熟情况。
共纳入50例患者（33例男孩和17例女孩），手术时平均年龄为13.2岁（范围9至16岁）。膝关节前侧平均侧方松弛度从术前的2.78毫米分别降至术后6、12和24个月时的1.59、1.80和1.30毫米（P<0.05）。随访及性别方面均未发现统计学差异。SNQ在6至12个月间无变化，但在12个月至24个月间有显著差异（P=0.008）。松弛度测量与移植物成熟之间无统计学相关性。
儿童和青少年的ACL移植物韧带化延迟，仅在术后12至24个月发生。移植物的残余松弛度测量和MRI信号可能成为决定恢复运动的多个依据之一。
