Moore Andrew, Rames Jess, McGurk Kathy, Slone Harris
Medical University of South Carolina, Charleston, South Carolina, USA.
Duke University, School of Medicine, Durham, North Carolina, USA.
Video J Sports Med. 2021 Oct 5;1(5):26350254211030289. doi: 10.1177/26350254211030289. eCollection 2021 Sep-Oct.
The incidence of pediatric anterior cruciate ligament (ACL) injuries has been increasing over the past 20 years, with the majority comprised of mid substance tears or tibial eminence avulsion fractures. Pediatric femoral sided osseous avulsion is rarely reported in orthopedic literature and specific surgical indications and contraindications, as well as recommended surgical techniques and postoperative rehabilitation protocols, are underdefined.
The surgical indications for femoral-sided repair of ACL osseous avulsion includes a displaced osseous fragment and ligamentous laxity on physical examination. There was no concomitant midsubstance tear necessitating reconstruction.
Two sutures piercing the proximal ligamentous bony junction of the ACL were fed through 2.4-mm transphyseal tunnels and secured with cortical button and backup fixation with a 3.9-mm swivel lock anchor in the proximal lateral femoral metaphysis. The patient was immobilized in a hinged-knee brace locked in extension during ambulation and limited to 90 degrees of flexion while nonweightbearing for the first 6 weeks after surgery. Standard ACL protocol was followed thereafter.
Successful fixation and restoration of ligamentous tension and impingement-free range of motion were achieved without complication. There was stable Lachman, negative pivot shift, 125 degrees of knee flexion, and evidence of early healing at 3 months follow-up.
DISCUSSION/CONCLUSION: This report demonstrates successful reduction and fixation of proximal bony avulsion of the ACL. Although this patient exhibits stable physical examination and undisturbed growth at early follow-up, more research is required to establish treatment and rehabilitation guidelines for this rare injury.
在过去20年中，小儿前交叉韧带（ACL）损伤的发生率一直在上升，其中大多数为韧带中部撕裂或胫骨髁间隆起撕脱骨折。小儿股骨侧骨撕脱在骨科文献中很少报道，具体的手术适应证和禁忌证以及推荐的手术技术和术后康复方案尚不明确。
ACL骨撕脱股骨侧修复的手术适应证包括体格检查时发现的移位骨块和韧带松弛。不存在需要重建的韧带中部撕裂。
两根穿过ACL近端韧带骨交界处的缝线穿过2.4毫米的经骨骺隧道，并用皮质纽扣固定，并在股骨近端外侧干骺端用3.9毫米旋转锁定锚进行辅助固定。患者在行走时用铰链膝关节支具固定于伸直位，术后前6周非负重时膝关节屈曲限制在90度。此后遵循标准的ACL方案。
成功实现固定，恢复韧带张力，且活动范围无撞击，无并发症。Lachman试验结果稳定，无轴移，膝关节屈曲125度，术后3个月随访有早期愈合迹象。
讨论/结论：本报告证明了ACL近端骨撕脱的成功复位和固定。尽管该患者在早期随访中体格检查结果稳定且生长未受影响，但仍需要更多研究来制定针对这种罕见损伤的治疗和康复指南。
