骨骼未成熟运动员采用软组织股四头肌腱自体移植物进行混合经骨骺前交叉韧带重建的中期结果
Midterm Outcomes of Hybrid Transepiphyseal ACL Reconstruction With Soft Tissue Quadriceps Tendon Autograft in Skeletally Immature Athletes.
作者信息
Seilern Und Aspang Jesse, Serrano-Dennis Jordan, Hammond Kyle E, Slone Harris S, Garry Jason G, Petit Camryn, Myer Gregory D, Seguin Danielle, Xerogeanes John W
机构信息
Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA.
Medical University of South Carolina, Department of Orthopaedics & Physical Medicine, Charleston, South Carolina, USA.
出版信息
Orthop J Sports Med. 2025 Mar 17;13(3):23259671251322758. doi: 10.1177/23259671251322758. eCollection 2025 Mar.
BACKGROUND
Substantial developments in physeal-sparing surgical techniques for anterior cruciate ligament (ACL) reconstruction (ACLR) have demonstrated safety and efficacy in treating skeletally immature patients. However, outcomes using all-soft tissue quadriceps tendon (QT) autograft in this population are unknown.
PURPOSE
To evaluate outcomes including return to sport (RTS) and reinjury risk in skeletally immature patients ≥2 years after undergoing hybrid transepiphyseal ACLR using QT autograft.
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
A consecutive series of skeletally immature patients who underwent primary QT autograft ACLR using a hybrid transepiphyseal technique with ≥2 years of follow-up were retrospectively analyzed. Outcomes included RTS (primary), ability to return to preinjury level of competition, and subsequent ipsilateral/contralateral knee injury (secondary).
RESULTS
A total of 50 patients were identified and contacted, of which 40 (80.0%) (35 male; mean age, 12.6 years [range, 9.4-16.0 years]) completed the survey at 5.7 ± 2.8 years (range, 2.0-11.5 years) postoperation. Of those, 26 (65.0%) were competitive middle/high school athletes and 18 (45.0%) competed in ≥2 sports. At a mean of 10.6 ± 2.3 months (range, 6-17 months) postoperatively, 37 patients (92.5%) returned to unrestricted sports participation, and 35 patients (87.5%) resumed competition at their preinjury level. Five patients required subsequent ipsilateral knee surgery for ACL revision (n = 2; 5.0%), meniscal injury (n = 2; 5.0%), or symptomatic hardware (n = 1; 2.5%) after a mean of 4.4 ± 1.7 years (range, 2.8-7.1 years). Three patients (7.5%) sustained a subsequent contralateral ACL injury, and 1 patient sustained a contralateral posterior cruciate ligament sprain.
CONCLUSION
Findings of this study suggest that midterm outcomes of patients treated with hybrid transepiphyseal ACLR using QT autograft are promising, with a high and expedited RTS and relatively low graft tear risk.
背景
用于前交叉韧带（ACL）重建（ACLR）的保留骺板手术技术取得了重大进展，已证明在治疗骨骼未成熟患者方面具有安全性和有效性。然而，该人群使用全软组织股四头肌腱（QT）自体移植物的结果尚不清楚。
目的
评估骨骼未成熟患者在接受使用QT自体移植物的混合经骺板ACLR术后≥2年的恢复运动（RTS）和再损伤风险等结果。
研究设计
病例系列；证据等级，4级。
方法
对一系列连续的骨骼未成熟患者进行回顾性分析，这些患者采用混合经骺板技术接受了初次QT自体移植物ACLR，且随访时间≥2年。结果包括RTS（主要指标）、恢复到伤前比赛水平的能力以及随后的同侧/对侧膝关节损伤（次要指标）。
结果
共确定并联系了50例患者，其中40例（80.0%）（35例男性；平均年龄12.6岁[范围9.4 - 16.0岁]）在术后5.7±2.8年（范围2.0 - 11.5年）完成了调查。其中，26例（65.0%）是有竞争力的初中/高中运动员，18例（45.0%）参加≥2项运动。术后平均10.6±2.3个月（范围6 - 17个月）时，37例患者（92.5%）恢复了无限制的运动参与，35例患者（87.5%）恢复到伤前的比赛水平。5例患者在平均4.4±1.7年（范围2.8 - 7.1年）后因ACL翻修（n = 2；5.0%）、半月板损伤（n = 2；5.0%）或有症状的内固定物（n = 1；2.5%）需要进行同侧膝关节手术。3例患者（7.5%）随后发生对侧ACL损伤，1例患者发生对侧后交叉韧带扭伤。
结论
本研究结果表明，使用QT自体移植物进行混合经骺板ACLR治疗的患者中期结果良好，RTS率高且恢复快，移植物撕裂风险相对较低。
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