Yalcin Sercan, Maier Jacob, Saluan Paul
Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
College of Medicine and Life Sciences, The University of Toledo, Toledo, Ohio, USA.
Video J Sports Med. 2022 Feb 17;2(1):26350254211056659. doi: 10.1177/26350254211056659. eCollection 2022 Jan-Feb.
The incidence of anterior cruciate ligament (ACL) tear in the skeletally immature pediatric population has been steadily increasing due to multiple factors, including multiple sports participation, year-round training, and the increase in the number of athletes. Reconstruction in these patients is challenging due to the open physes at the distal femur, proximal tibia, and tibial tuberosity apophysis. Violation of the physis can result in angular deformities or leg length discrepancies.
To demonstrate steps of all epiphyseal ACL reconstruction in skeletally immature patients using quadriceps tendon autograft.
After the patient is positioned, prepped, and draped, the quadriceps tendon autograft is harvested and prepared to be used as the autograft. Using the all-inside technique, femoral and tibial tunnels are created as all-epiphyseal to prevent violating the physes. The ends of the graft are then passed through the tunnels and fixed with an adjustable loop on the femur and a button on the tibia.
Although excellent clinical outcomes and a high return to sports rates have been reported after ACL reconstruction, the technique to be chosen is not clear yet.
DISCUSSION/CONCLUSION: Quadriceps tendon autograft provides an excellent alternative as a graft choice in skeletally immature patients.
由于多种因素，包括参与多项运动、全年训练以及运动员数量增加，骨骼未成熟的儿童人群中前交叉韧带（ACL）撕裂的发生率一直在稳步上升。由于股骨远端、胫骨近端和胫骨结节骨骺处的骨骺开放，这些患者的重建具有挑战性。损伤骨骺可导致角畸形或腿长差异。
展示使用股四头肌肌腱自体移植对骨骼未成熟患者进行全骨骺ACL重建的步骤。
患者体位摆放、准备和铺巾后，采集股四头肌肌腱自体移植并准备用作自体移植。采用全关节镜技术，创建全骨骺的股骨和胫骨隧道，以防止损伤骨骺。然后将移植物的两端穿过隧道，在股骨上用可调环固定，在胫骨上用纽扣固定。
尽管ACL重建术后报告了优异的临床结果和较高的重返运动率，但尚未明确应选择的技术。
讨论/结论：股四头肌肌腱自体移植作为骨骼未成熟患者的移植物选择提供了一个极好的替代方案。
