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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >RETURN TO SPORT AND REOPERATION RATES IN PATIENTS UNDER THE AGE OF 20 FOLLOWING PRIMARY ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: RISK PROFILE COMPARING THREE PATIENT GROUPS PREDICATED UPON SKELETAL AGE
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RETURN TO SPORT AND REOPERATION RATES IN PATIENTS UNDER THE AGE OF 20 FOLLOWING PRIMARY ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: RISK PROFILE COMPARING THREE PATIENT GROUPS PREDICATED UPON SKELETAL AGE

机译：原发性前十字韧带重建后20岁以下患者的运动和重组率：风险简介比较骨骼时代预测的三个患者群体

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Background: With sports specialization and level of competition on the rise, anterior cruciate ligament reconstruction (ACLR) in skeletally immature athletes has increased significantly in recent years. Reports have demonstrated that the revision ACLR rate is higher and return to sport (RTS) rate is lower in this high-risk population. The purpose of this study is to evaluate two year clinical outcomes of three groups of primary ACLR in pediatric and adolescent athletes under the age of 20 based on skeletal age, school grade distribution, and ACLR technique with a focus on RTS and incidence of second surgery. Methods: This is a prospective evaluation of 324 athletes under 20 years of age following ACLR with minimum 2-year follow-up. The surgical technique was selected predicated upon skeletal age which includes the all-epiphyseal (AE) technique with hamstring autograft in the youngest cohort in lower and middle school (Group 1), the partial transphyseal (PTP) and complete transphyseal (CT) with hamstring autograft performed for athletes in the middle cohort (Group 2), and bone tendon bone autograft (BTB) in the skeletally mature high school athletes (Group 3). Preoperative demographics, sport, mechanism of injury, intraoperative findings, RTS, and second surgery data were collected. Athletes were followed for a minimum of 24 months with serial clinic visits. Results: The mean chronological age of the entire cohort was 15 years (range 8 to 19 years) with 55% males. The mean post-operative duration of follow-up was 3.25 years (range 2-7 years). The three cohorts included 49 patients (15%) in Group 1 (mean age: 12y), 66 (20%) in Group 2 (mean age: 14.3y), and 209 (65%) in Group 3 (mean age: 16.2y). Group 2 athletes had a significantly higher revision ACLR rate (20%) compared to Groups 1 (6%) and 3 (6%) (Table 1). When separated based on gender, there was a significantly higher rate of revision ACLR for males between groups. Post-hoc analysis revealed a significantly higher rate of revision ACLR for the males in Group 2 (24%) compared to Groups 1 (8%) and Group 3 (5%). Group 2 athletes also had significantly lower RTS rates (85%) compared to Groups 1 (100%) and 3 (94%). Multi-variate logistic regression analyses demonstrated that Group 2 athletes were more than 4 times more likely to have a revision ACLR compared to Group 3 (OR: 4.21, 95% CI: 1.09 – 16.3, p=0.037). With regard to gender, females were nearly three times more likely to have a contralateral ACLR compared to males (OR: 2.80, 95% CI: 1.11 – 7.06, p=0.029). Conclusions/Significance: The rate of revision ACLR was significantly higher and the RTS rates significantly lower in Group 2 compared to Groups 1 and 3. This age-related risk profile may be used to counsel athletes and parents preoperatively regarding the expectations of surgery with respect to revision ACLR and RTS rates. This study is unique in that it describes a particularly high-risk group of skeletally immature athletes within what is already considered to be a high-risk population of athletes less than 20 years of age. We believe this is the first report to identify a skeletally immature cohort of athletes bridging middle school and high school with higher revision ACLR and lower RTS rates compared to a younger cohort of skeletally immature lower and middle school athletes and an older group of skeletally mature high school and college adolescents. This study also reports relatively low rates of revision ACLR and high rates of RTS in the youngest cohort of skeletally immature athletes. Table 1: 2 ~(nd) Surgery Rate Group 1 AE Group 2 TP/PTP Group 3 BTB p value Revision ACL Total 6% 20% 6% 0.001** M 8% 24% 6% 0.003** F 0% 10% 5% 0.512
机译：背景：近年来，随着体育专业化和竞争水平上升，近年来骨骼不成熟运动员的韧带重建（ACLR）显着增加。报告表明，在这种高风险群体中，修订ACLR率较高，返回运动（RTS）率较低。本研究的目的是根据骨骼时代，学校级分布和ACLR技术重点评估20岁以下的儿科和青少年运动员的三组原发性ACLR临床结果，重点是RTS和第二次手术的发病率。方法：这是在ACLR后20岁以下的324名运动员的前瞻性评估，最低2年后续随访。在骨骼时期选择外科技术，该骨骼时期包括所有骨骺（AE）技术，中下和中学（第1组）中最小的群组中的HAMString自体移植物，部分转基因（PTP）并用腿筋完成或完全转椎间口（CT）在骨骼成熟的高中运动员（第3组）中，对中间队列（第2组）和骨肌腱骨自体移植（BTB）进行的自体移植物。收集了术前人口统计，体育，损伤机制，术中发现，RTS和第二次手术数据。串行诊所访问后，运动员持续至少24个月。结果：整个队列的平均年龄年龄为15年（8至19年），男性为55％。随访的平均术后持续时间为3.25岁（范围2-7岁）。第1组（平均年龄：12Y），第2组（平均年龄：14.3y），66（20％），第3组（平均年龄：16.2）（平均年龄：16.2） y）。第2组运动员与第1组（6％）和3（6％）相比具有明显更高的修订ACLR率（20％）（表1）。基于性别分离时，群体之间的男性的修复ACLR率明显较高。与组1（8％）和第3组（5％）相比，HOC分析显示2（24％）中的男性的雄性的修复ACLR率明显较高。与第1组（100％）和3（94％）相比，第2组运动员也显着降低了RTS率（85％）。与第3组（或：4.21,95％CI：1.09 - 16.3，P = 0.037）相比，多变量逻辑回归分析表明，第2组运动员具有修复ACLR的可能性较可能的可能性可能更少4倍。对于性别，与男性相比，女性近三倍可能会有对侧ACLR的可能性（或：2.80,95％：1.11 - 7.06，P = 0.029）。结论/意义：修订ACLR率明显升高，与第1组和3组第2组的RTS率显着降低。该年龄相关的风险简介可用于术前咨询运动员和父母对手术的期望修改ACLR和RTS率。本研究具有独一无二的，因为它描述了一个特别高风险的骨架不成熟运动员，其中被认为是不到20岁的运动员的高危人群。我们认为这是第一个识别桥接中学和高中的骨骼不成熟的运动员桥梁和高中的第一份报告，与更高的骨骼不成熟的下游和中学运动员和较大的骨骼成熟高等群体相比，较低的RTS汇率学校和大学青少年。本研究还报告了最年轻的骨骼未成熟运动员队列中的修订ACLR和RTS的高率相对较低。表1：2〜（ND）手术率组1 AE组2 TP / PTP组3 BTB P值修正ACL总共6％20％6％0.001 ** M 8％24％6％0.003 ** F 0％10％ 5％0.512

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