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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: Early Results Using a Hybrid Physeal-Sparing Technique
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Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: Early Results Using a Hybrid Physeal-Sparing Technique

机译：骨骼发育不全患者的前十字韧带重建：使用混合体力节省技术的早期结果

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Background: Reconstruction of the anterior cruciate ligament (ACL) in the skeletally immature patient is frequently performed in hopes of preventing new or additional chondral damage and meniscal injuries. Patients within a few years of skeletal maturity are more at risk for ACL injuries than prepubescent patients, about whom several physeal-sparing techniques have been described. Reconstruction techniques in the former higher risk group need to be better understood. Purpose: To review a series of adolescent patients with ACL injuries surgically treated with the hybrid physeal-sparing technique. Study Design: Case series; Level of evidence, 4. Methods: Surgical logs of ACL reconstructions (ACLRs) performed at a single pediatric/adolescent sports medicine center over a 6-year period were reviewed. Patients with open physes who had undergone ACLR with a femoral physeal-sparing tunnel and transphyseal tibial tunnel were identified. Their demographics, operative reports, rehabilitative course, time to return to play, outcome scores, and postoperative radiographs were collected and analyzed. Results: Twenty-three patients with a mean chronological age and bone age of 13.0 and 13.6 years, respectively, were identified. Examination and subjective outcome scores were obtained at a mean of 19 months and overall demonstrated positive results, with a mean Pediatric International Knee Documentation Committee (Pedi-IKDC) score of 96.0 and a mean Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) score of 89.1. Full-length mechanical axis films obtained at a mean 21 months postoperatively demonstrated no leg-length discrepancies or angular deformities in 21 of 23 patients. Two patients had an identified growth disturbance in the form of femoral and tibial growth acceleration on the ACL-reconstructed limb. Conclusion: The femoral physeal-sparing with transphyseal tibial drilling “hybrid” technique in skeletally maturing patients appears to have a high rate of success with low morbidity. However, the possibility of physeal abnormalities does exist, which demonstrates the importance of a close postoperative follow-up and evaluation until skeletal maturity is achieved. ACLR in skeletally immature patients is performed on an increasingly regular basis. Establishing the best and safest technique to do so is therefore important.
机译：背景：骨骼未成熟的患者经常进行前交叉韧带（ACL）重建，以防止新的或额外的软骨损伤和半月板损伤。骨骼成熟几年内的患者比青春期前的患者更有可能发生ACL损伤，关于青春期前的患者，已经描述了几种骨干保留技术。前高危人群的重建技术需要更好地理解。目的：回顾一系列采用混合植骨保留技术手术治疗的青少年ACL损伤患者。研究设计：案例系列;证据等级：4。方法：回顾了在单个儿童/青少年运动医学中心进行的6年内ACL重建（ACLR）的手术记录。确定患有开放性植骨的患者，该患者已通过股骨干植骨通道和胫骨干植骨通道接受了ACLR。收集并分析他们的人口统计学，手术报告，康复过程，恢复玩耍的时间，结果评分和术后X光片。结果：确定了23例患者，其平均年龄分别为13.0岁和骨龄为13.6岁。平均19个月获得考试和主观结果评分，总体上显示出积极的结果，小儿国际膝关节文献委员会（Pedi-IKDC）的平均评分为96.0，前交叉韧带–受伤后恢复运动的平均评分（ACL- RSI）得分为89.1。术后平均21个月获得的全长机械轴膜显示，在23例患者中有21例没有腿长差异或角畸变。两名患者在ACL重建肢体上以股骨和胫骨生长加速的形式出现了确定的生长障碍。结论：骨干成熟患者采用经phy骨胫骨钻孔“混合”技术进行股骨s骨保留似乎具有较高的成功率，而发病率较低。但是，确实存在骨s异常的可能性，这表明了在骨骼成熟之前进行密切的术后随访和评估的重要性。骨骼不成熟患者的ACLR越来越有规律。因此，建立最佳和最安全的技术来做到这一点很重要。

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