儿童运动员采用Over-the-Top前交叉韧带重建联合膝外侧关节外腱固定术可获得优异的功能结果并保护生长板对称性
简介
一项纳入19例骨骼未成熟足球运动员（平均12.8岁）的回顾性研究显示，采用over-the-top技术联合外侧关节外肌腱固定术（LET）进行ACL重建，平均随访43.6个月后Lysholm评分达96.7分，仅1例再断裂（5.6%）。影像学评估提示双下肢力线及骨长度对称，但手术侧机械内侧胫骨近端角较对侧减小1.5°（85.0° vs 86.5°）。该技术在不损…
英文摘要
PURPOSE: To assess clinical and radiological outcomes of pediatric anterior cruciate ligament (ACL) reconstruction using the over-the-top technique (OTT) combined with the lateral extra-articular tenodesis (LET) technique in skeletally immature patients, providing insights into its safety, efficacy, and effects on the growing knee. METHODS: A retrospective study was conducted on skeletally immature soccer players undergoing ACL reconstruction with OTT + LET between 2019 and 2023 with a minimum follow-up of 2 years. Functional assessment included Lysholm, Knee Injury and Osteoarthritis Outcome Score, as well as KT-1000 testing. Radiological parameters included mechanical axis deviation, mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, anterior superior iliac spine-medial malleolus distance, femoral/tibial lengths, and limb alignment. Paired t-tests/Wilcoxon tests were used, with P < .05 considered significant. RESULTS: Nineteen skeletally immature soccer players (mean age 12.8 ± 0.9 years) underwent ACL reconstruction with OTT + LET. At a mean follow-up of 43.6 ± 15.9 months [28-75], patients showed excellent functional outcomes (Lysholm 96.7 ± 10.9; Knee Injury and Osteoarthritis Outcome Score 94.6 ± 9.4). Clinical stability was restored in 94.4% of cases, with only 1 rerupture (5.6%). Radiological comparisons showed symmetrical alignment and bone lengths. A statistically significant reduction in mechanical medial proximal tibial angle was observed in operated knees compared with contralateral knees (85.0° vs 86.5°, P = .003). CONCLUSIONS: ACL reconstruction using the OTT physeal-sparing technique combined with LET provided excellent clinical outcomes in our small sample of skeletally immature athletes. At a minimum of 2 years of follow-up, functional results were favorable, stability was restored, and radiological findings showed overall limb symmetry. The only significant radiological difference was a reduction of 1.5° in the mechanical medial proximal tibial angle. LEVEL OF EVIDENCE: Level IV, retrospective therapeutic case series.