Astur Diego Costa, Costa José Ricardo Dantas Moura, Amaro Joicemar Tarouco, Kaleka Camila Cohen, V Silva Pedro Debieux, de Oliveira Pedro Paulo Paes, Britto Raymundo José Magalhaes, da Silva Gustavo Montibeller, Cohen Moisés
Hospital Israelita Albert Einstein, São Paulo, Brazil.
São Paulo Federal University, São Paulo, Brazil.
Video J Sports Med. 2023 Sep 25;3(5):26350254231195092. doi: 10.1177/26350254231195092. eCollection 2023 Sep-Oct.
Anterior cruciate ligament (ACL) injury in children is an increasingly common occurrence. Historically, nonsurgical treatment has been the main treatment option; however, the indication for surgical reconstruction is increasing, as the histological characteristics of the immature skeleton are better known.
The extra-articular surgical technique for ACL reconstruction is a good option for Tanner I patients, aged up to 8 years, with knee instability and recurrent pain. Its advantage in skeletally immature patients is due to the fact that it avoids the bone growth plates.
After skin incision and subcutaneous dissection, we isolated the iliotibial band and released the proximal portion of the band. We proceeded with the tubularization of the graft, suturing its edges, and with the aid of radioscopy we marked the top of the lateral femoral condyle. Thus, we transported the graft, in an over-the-top position, to the intercondylar portion of the femur. Femoral fixation is performed by placing the graft close to the lateral femoral condyle. For fixation on the tibia, a second incision is made, preserving the physis, and the graft is fixed to the tibia using an absorbable Swivelock anchor.
Six months after the surgery, when his physical rehabilitation was completed, the patient was asymptomatic and able to perform his daily activities, and also returned to sports. Clinical evaluation showed a knee with almost the same functional parameters as the uninjured one. Furthermore, radiographic studies showed no bone abnormalities and magnetic resonance image showed a newly reconstructed ligament with good positioning.
DISCUSSION/CONCLUSION: According to the literature, surgical treatment seems to be better than conservative treatment in skeletally immature patients. However, there is a continuous discussion about the most appropriate surgical technique. The decision is relative to many specific characteristics for these patients: age, bone age, graft choice, sports modality, and surgeon expertise. In this case, we decide to do an ACL extra-articular reconstruction technique with the iliotibial band over the top in the femoral condyle and fixed in the anterior cortical bone of the tibia.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
儿童前交叉韧带（ACL）损伤越来越常见。历史上，非手术治疗一直是主要的治疗选择；然而，随着对未成熟骨骼组织学特征的了解日益深入，手术重建的适应证也在增加。
ACL重建的关节外手术技术对于年龄在8岁及以下、患有膝关节不稳定和复发性疼痛的坦纳I期患者是一个不错的选择。它在骨骼未成熟患者中的优势在于避免了骨骺生长板。
在皮肤切口和皮下剥离后，我们分离了髂胫束并松解了其近端部分。我们对移植物进行管状化处理，缝合其边缘，并借助荧光镜检查标记了股骨外侧髁的顶部。然后，我们将移植物以过顶的位置转移到股骨髁间部分。通过将移植物靠近股骨外侧髁进行股骨固定。为了在胫骨上固定，需做第二个切口，保留骨骺，并用可吸收的旋转锁定锚将移植物固定到胫骨上。
手术后六个月，当患者完成身体康复时，无症状且能够进行日常活动，还恢复了运动。临床评估显示患侧膝关节的功能参数几乎与未受伤侧相同。此外，影像学研究未显示骨骼异常，磁共振成像显示新重建的韧带位置良好。
讨论/结论：根据文献，在骨骼未成熟患者中，手术治疗似乎优于保守治疗。然而，对于最合适的手术技术一直存在持续的讨论。该决定与这些患者的许多具体特征有关：年龄、骨龄、移植物选择、运动方式和外科医生的专业技能。在本病例中，我们决定采用髂胫束在股骨髁上过顶并固定于胫骨前皮质骨的ACL关节外重建技术。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本提交的出版物包含患者的豁免声明或其他书面批准形式。
