Age and Sex-based Frequency of Graft and Technique Used in Pediatric Anterior Cruciate Ligament Reconstruction: A Multicenter Study.

IF 1.5 3区 医学 Q3 ORTHOPEDICS
Journal of Pediatric Orthopaedics Pub Date : 2025-09-01 Epub Date: 2025-04-16 DOI:10.1097/BPO.0000000000002983
Emily L Niu, Matthew R Schmitz, V Claire Clark, Caroline C Podvin, Theodore J Ganley, Daniel W Green, Michael G Saper, Donna M Pacicca, Matthew D Ellington, Philip L Wilson, Kevin G Shea, Henry B Ellis
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引用次数: 0

Abstract

Objective: As the incidence of pediatric and adolescent anterior cruciate ligament (ACL) reconstruction rises, knowledge of contributing factors to decision-making regarding graft selection and technique is important. Variations in ACL reconstruction (ACLR) regarding graft choice, tunnel placement, and technique may depend on patient age, sex, and surgeon preference. The purpose of this study was to review technique and graft source of pediatric ACLR based on these factors.

Methods: A prospective, surgeon-driven, multicenter quality/performance improvement registry was queried to evaluate graft selection and technique in primary ACLR. Data regarding ACLR in those 19 years or younger performed by 23 contributing surgeons was collected. Frequency of graft use and surgical technique were stratified by patient age and sex.

Results: A total of 3968 ACLRs were included, with an average age of 15.1 years (range: 6 to 19 years), 53.7% males, with a majority using autograft (97.4%). Of ACLR, 82.9% of those under age 11 used iliotibial band (ITB) graft and extra-articular extraphyseal technique. ITB use was similar in females (80.0%) and males (83.5%). For ages 11 to 15, soft tissue quadriceps (STQT, 38.1%), hamstring (HS, 23.5%), and ITB (16.6%) were most frequently used. STQT use was 40.1% in females and 36.2% in males. ITB was used more in males than females (25.6% and 7.4%, respectively). After age 15, STQT (30.9%), bone patellar tendon bone (BTB, 27.8%), and HS (24.8%) were most common. STQT was the dominant graft in females (35.5%) in this group, while BTB (32.3%) was the most frequent in males. When comparing the early (2018 to 2020) to the late (2020 to 2022) portion of collection period, quadriceps tendon autograft use increased from 30.5% to 48.0%.

Conclusions: Variation exists in graft selection and technique for pediatric and adolescent ACLR. ITB, extra-articular extraphyseal technique, is favored in patients under age 11. Quadriceps autograft use has increased in ACLR in this patient population in recent years.

Level of evidence: Level III-retrospective cohort study.

儿童前交叉韧带重建中基于年龄和性别的移植物频率和技术:一项多中心研究。
目的:随着儿童和青少年前交叉韧带(ACL)重建发生率的上升,了解影响移植物选择和技术决策的因素是很重要的。ACL重建(ACLR)在移植物选择、隧道放置和技术方面的差异可能取决于患者的年龄、性别和外科医生的偏好。本研究的目的是回顾基于这些因素的儿童ACLR的技术和移植物来源。方法:通过前瞻性、外科医生驱动、多中心质量/性能改进登记来评估原发性ACLR的移植物选择和技术。收集了23位贡献外科医生19岁及以下患者的ACLR数据。根据患者的年龄和性别对移植物使用频率和手术技术进行分层。结果:共纳入ACLRs 3968例,平均年龄15.1岁(6 ~ 19岁),男性53.7%,以自体移植物为主(97.4%)。在ACLR中,82.9%的11岁以下患者采用髂胫束(ITB)移植和关节外干外技术。女性(80.0%)和男性(83.5%)使用ITB相似。在11 - 15岁年龄组中,最常使用的是软组织股四头肌(STQT, 38.1%)、腘绳肌(HS, 23.5%)和ITB(16.6%)。STQT的使用率女性为40.1%,男性为36.2%。男性使用ITB的比例高于女性(分别为25.6%和7.4%)。15岁以后以STQT(30.9%)、骨髌腱骨(BTB, 27.8%)和HS(24.8%)最为常见。STQT在本组女性中占主导地位(35.5%),而BTB在男性中最常见(32.3%)。与采集期早期(2018 - 2020年)和后期(2020 - 2022年)相比,自体股四头肌肌腱移植的使用率从30.5%增加到48.0%。结论:儿童和青少年ACLR的移植物选择和技术存在差异。ITB,关节外干外技术,适用于11岁以下的患者。近年来,在ACLR患者群体中,自体股四头肌移植的使用有所增加。证据等级:iii级回顾性队列研究。
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来源期刊
CiteScore
3.30
自引率
17.60%
发文量
512
审稿时长
6 months
期刊介绍: ​Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.
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