骨未成熟青少年患者部分经骨骺全内前交叉韧带重建:两年最短随访临床和放射学结果。

IF 2.4 3区 医学 Q2 ORTHOPEDICS
Orthopaedic Journal of Sports Medicine Pub Date : 2025-06-26 eCollection Date: 2025-06-01 DOI:10.1177/23259671251350298
Alessandro Carrozzo, Edoardo Monaco, Adnan Saithna, Matteo Romano Cantagalli, Nicola Carlo Bianco, Serena Ciacio, Alessandro Annibaldi, Nicola Maffulli
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引用次数: 0

摘要

背景:前交叉韧带(ACL)损伤在儿科和青少年人群已经看到上升,由于竞技体育的参与增加。治疗模式已经从非手术治疗转向早期重建,以防止半月板和软骨损伤。然而,对于最佳重建技术尚无共识,特别是在骨骼发育不成熟的患者中。目的/假设:本研究的目的是评估有限经骨骺全内ACL重建(ACLR)技术的有效性和安全性,假设在至少2年的随访中,该技术将产生良好的临床结果,没有生长障碍、移植物失败或并发症。研究设计:病例系列;证据等级,4级。方法:纳入2015年1月至2021年6月在罗马圣安德烈亚大学医院接受ACLR的连续患者,年龄在10至18岁之间。排除标准为闭合性肢体、既往膝关节手术和多韧带损伤。在ACLR中,通过仔细控制隧道的大小、方向和深度,采用有限的经骨骺全内技术将骨骺损伤降到最低。术后2周、6周、3、6、12、24个月对患者进行标准化随访。此外,在2023年2月至8月期间召回所有患者进行最终评估。最终评估包括体格检查(活动范围、枢轴移位、拉赫曼试验、活动量计测量的松弛度、肢体长度差异和畸形)和完成患者报告的结果测量(PROMs)。术后长期正位x线片评估生长障碍。通过测量信噪比(SNQ)、隧道拓宽、移植物愈合和移植物成熟度进行全面的磁共振成像(MRI)评估。结果:总体而言,24例患者符合纳入标准,平均年龄14.2岁。平均随访53.1个月(28-90),移植物破裂率为12.5%,对侧ACL破裂率为8.3%。总体而言,在接受放射学评估的患者中,生长障碍的发生率为15.8%。这些病例包括>角度畸形5°或>肢体长度差异10 mm。平均四肢长度差异为0.31 cm,肢体排列无显著差异。MRI分析显示胫骨隧道平均加宽5.1%,平均SNQ为2.85±0.91(范围1.5-4.4)。使用Howell分级系统评估的移植物成熟度,50%的患者被分类为1级,其余50%的患者被分类为2级,而移植物愈合被分类为60%的1级和40%的2级;在这两项测试中,分数越低,结果越好。PROMs在膝关节损伤和骨关节炎结局评分、国际膝关节文献委员会评分和Lysholm评分中得分较高,术后Tegner活动评分中位数为7分。所有患者均恢复体育活动。结论:有限的经骨骺全内ACLR在骨骼发育不成熟的患者中表现出良好的临床效果和较低的显著生长障碍率,表明它是一种有效且安全的技术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Partial Transphyseal All-Inside Anterior Cruciate Ligament Reconstruction in Skeletally Immature Adolescent Patients: Two-Year Minimum Follow-up Clinical and Radiologic Results.

Background: Anterior cruciate ligament (ACL) injuries in pediatric and adolescent populations have seen an uptick due to increased competitive sports participation. Treatment paradigms have shifted from nonoperative management to early reconstruction to prevent meniscal and cartilage damage. However, no consensus exists on the optimal reconstruction technique, particularly in skeletally immature patients.

Purpose/hypothesis: The purpose of this study was to evaluate the efficacy and safety of a limited transphyseal all-inside ACL reconstruction (ACLR) technique, hypothesizing that it would yield favorable clinical results without growth disturbances, graft failure, or complications at minimum 2-year follow-up.

Study design: Case series; Level of evidence, 4.

Methods: Consecutive patients aged between 10 and 18 years undergoing ACLR at Sant'Andrea University Hospital of Rome from January 2015 to June 2021 were enrolled. Exclusion criteria were closed physes, previous knee surgeries, and multiligament injuries. The limited transphyseal all-inside technique was used to minimize physeal damage during ACLR by carefully controlling tunnel size, orientation, and depth. Patients underwent standardized follow-ups at 2 and 6 weeks and at 3, 6, 12, and 24 months postoperatively. In addition, all patients were recalled for a final evaluation between February and August 2023. The final assessment included a physical examination (range of motion, pivot shift, Lachman test, Rolimeter-measured laxity, limb-length discrepancy, and deformity) and completion of patient-reported outcome measures (PROMs). Postoperative longstanding anteroposterior radiographs were obtained to evaluate radiographic growth disturbance. A comprehensive magnetic resonance imaging (MRI) assessment was performed by measuring the signal-to-noise quotient (SNQ), tunnel widening, graft healing, and graft maturity.

Results: Overall, 24 patients met inclusion criteria, with a mean age of 14.2 years. At a mean follow-up of 53.1 months (range, 28-90), the graft rupture rate was 12.5%, and the contralateral ACL rupture rate was 8.3%. Overall, the incidence of growth disturbances was 15.8% in patients who underwent radiologic evaluation. These included cases of angular deformity of >5° or limb-length discrepancy of >10 mm. The mean limb-length discrepancy was 0.31 cm, with no significant differences in limb alignment. MRI analysis revealed a mean tibial tunnel widening of 5.1%, and the mean SNQ was 2.85 ± 0.91 (range, 1.5-4.4). Graft maturity, assessed using the Howell grading system, was classified as grade 1 in 50% of patients and grade 2 in the remaining 50%, while graft healing was graded as 1 in 60% and 2 in 40%; in both, lower grades indicated better results. PROMs showed high scores for Knee injury and Osteoarthritis Outcome Score, International Knee Documentation Committee, and Lysholm scales, with a postoperative median Tegner activity scale score of 7. All patients returned to sports activities.

Conclusion: Limited transphyseal all-inside ACLR in skeletally immature patients demonstrated promising clinical outcomes and a low rate of significant growth disturbances, suggesting that it is an effective and safe technique for this population.

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来源期刊
Orthopaedic Journal of Sports Medicine
Orthopaedic Journal of Sports Medicine Medicine-Orthopedics and Sports Medicine
CiteScore
4.30
自引率
7.70%
发文量
876
审稿时长
12 weeks
期刊介绍: The Orthopaedic Journal of Sports Medicine (OJSM), developed by the American Orthopaedic Society for Sports Medicine (AOSSM), is a global, peer-reviewed, open access journal that combines the interests of researchers and clinical practitioners across orthopaedic sports medicine, arthroscopy, and knee arthroplasty. Topics include original research in the areas of: -Orthopaedic Sports Medicine, including surgical and nonsurgical treatment of orthopaedic sports injuries -Arthroscopic Surgery (Shoulder/Elbow/Wrist/Hip/Knee/Ankle/Foot) -Relevant translational research -Sports traumatology/epidemiology -Knee and shoulder arthroplasty The OJSM also publishes relevant systematic reviews and meta-analyses. This journal is a member of the Committee on Publication Ethics (COPE).
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