骨骼未成熟患者年龄特异性前交叉韧带过顶重建联合外侧关节外肌腱固定术：早期随访无严重并发症
简介
该前瞻性病例系列纳入84例骨骼未成熟患者（平均14.7岁），根据剩余生长潜力选择不同胫骨隧道策略（骺外12%、骺上48%、经骺40%），采用over-the-top ACL重建联合LET技术。早期随访（平均20个月）未见严重并发症，轻微并发症发生率20.2%（以短暂僵硬、早期肿胀/发热为主），再手术率4.7%。提示该技术在骨骼未成熟患者中早期安全性良好，但需…
英文摘要
PURPOSE: To assess the rate of early complications and reoperation after anterior cruciate ligament reconstruction (ACLR) using an over-the-top technique with lateral extra-articular tenodesis (LET) in skeletally immature patients. METHODS: This prospective case series included all skeletally immature patients undergoing ACLR with an over-the-top technique and LET augmentation between June 2022 and August 2025, performed by a single surgeon. Tibial tunnel strategy (extra-physeal, supra-physeal or trans-physeal) was selected based on remaining growth. Skeletal immaturity was defined by the presence of open physes on knee magnetic resonance imaging. All patients had a minimum follow-up of 9 months. The primary outcome was the rate of complications and reoperations within the first 9 post-operative months, selected to capture events occurring during the rehabilitation phase prior to return to sport. Secondary outcomes included patient characteristics, sports activity, surgical technique and associated meniscal injuries. RESULTS: Eighty-four patients (mean age 14.7 ± 1.7 years; 77% male) were included, with a mean follow-up of 20.0 ± 9.7 months. Surgical techniques included extra-physeal (12%), supra-physeal (48%) and trans-physeal (40%) approaches. Concomitant meniscal lesions were treated in 71 patients. No major complications were observed. Minor complications occurred in 20.2% of patients, with similar rates across techniques. The most common events were transient stiffness (9.5%), early swelling/fever (8.3%), delayed wound healing (7.4%) and hardware irritation (2.4%). Reoperations occurred in 4.7% of cases, all before return to sport, and included hardware removal, wound debridement and joint lavage. No deep infections or septic arthritis were reported. CONCLUSION: ACLR using an over-the-top technique with LET in skeletally immature patients was not associated with major complications during the early postoperative period. Minor complications were observed in approximately one-fifth of patients and were generally self-limiting or managed without long-term consequences. Longer follow-up is required to evaluate growth-related outcomes and graft survivorship. LEVEL OF EVIDENCE: Level IV, case series.