儿童和青少年前交叉韧带重建术后生长相关并发症的五年MRI随访
简介
该前瞻性研究对50例骨骺未闭儿童青少年行经骺板ACL重建，术后5年MRI随访16例，评估胫骨及股骨骨骺-骨干角、Harris生长停滞线、骨桥形成等指标。结果显示骨骺-骨干角随时间稳定，37.5%出现轻微角度偏差（最大-6°至+5°）但无临床意义，18.8%出现骨桥但均自行消退，无骨骺早闭。结论支持经骺板ACL重建在骨骺未闭患者中安全性良好，生长相关并发症风险…
英文摘要
BACKGROUND: Growth-related complications are a concern in skeletally immature patients undergoing anterior cruciate ligament reconstruction (ACLR). Reported outcomes of growth disturbances following ACLR in this population are heterogeneous. PURPOSE: We hypothesized that transphyseal ACLR performed with a standardized technique results in mild radiological, but clinically non-significant growth disturbances. METHODS: This single-center study prospectively enrolled 50 patients with open growth plates undergoing transphyseal ACLR. Magnetic resonance imaging of the operated knee was performed preoperatively and at 6, 12, 24, and 60 months postoperatively. Growth-related outcomes included tibial and femoral physeal-diaphyseal angles in coronal and sagittal planes, Harris growth arrest line deviation, focal physeal bone bridge formation, physeal violation by tunnels, skeletal maturity, and premature physeal closure. Growth disturbances were also evaluated clinically. RESULTS: Sixteen patients completed the 60-month follow-up. Eighty-seven point five percent had reached skeletal maturity by then. Physeal-diaphyseal angles remained stable over time, with no significant differences between preoperative and 60-month measurements (medial tibial physeal angle, p-value = 0.20; lateral femoral physeal angle, p-value = 0.91; posterior tibial physeal angle, p-value = 0.16; posterior femoral physeal angle, p-value = 0.30). Angular deviations (≥ ±5°) were identified in 37.5% of cases, but were minimal (max -6° and + 5°) and clinically insignificant. Bone bridges were observed in three patients (18.8%) and resolved spontaneously. No premature physeal closure or Harris growth arrest line deviation was identified. Mean physeal violation was minimal. SIGNIFICANCE OF STUDY: This study supports the safety of transphyseal ACLR in skeletally immature patients. CONCLUSIONS: Transphyseal ACLR in skeletally immature patients appears to be associated with minimal physeal injury and a low risk of clinically relevant growth disturbances. LEVEL OF EVIDENCE: IV, Retrospective case series of prospectively enrolled patients.