改良Lemaire膝关节外固定术联合前交叉韧带重建术在青少年短期随访中可获得良好的主观膝关节功能
简介
该前瞻性队列研究纳入55例青少年（中位年龄16.8岁），采用腘绳肌腱自体移植物行ACL重建联合改良Lemaire外侧关节外腱固定术，平均随访28.7个月。结果显示主观膝关节功能良好（Lysholm中位94.0，IKDC中位85.0），96.4%患者术后12个月重返运动，但移植物失败率9.1%、再干预率16.4%。虽为IV级证据且无对照组，但对青少年高风险人群…
英文摘要
INTRODUCTION/OBJECTIVE: Anterior cruciate ligament (ACL) reconstruction in adolescents is associated with higher graft failure rates than in adults. Lateral extra-articular tenodesis (LET) may improve rotational stability and potentially reduce graft failure in this high-risk population. This study aimed to evaluate functional outcomes, return to sport (RTS), graft failure, and reintervention rates in adolescents undergoing ACL reconstruction combined with modified Lemaire LET. METHODS: This prospective single-center cohort included patients younger than 18 years who underwent primary ACL reconstruction using hamstring autograft combined with modified Lemaire LET and had a minimum follow-up of 12 months. Outcomes included the Lysholm score, International Knee Documentation Committee (IKDC) Subjective Knee Form, RTS rate and timing, graft failure, and reinterventions. RESULTS: Fifty-five patients were included, with a median age of 16.8 years (IQR, 16.1-17.6); 36 patients were male (65.5%). The mean follow-up was 28.7 months (range, 12-36 months). At final follow-up, the median Lysholm score was 94.0 (IQR, 89.5-96.0), and the median subjective IKDC score was 85.0 (IQR, 80.0-89.0). RTS was achieved in 53 patients (96.4%) at a median of 12.0 months after surgery (IQR, 11.8-13.0). Graft failure occurred in five patients (9.1%) at a median of 17.0 months postoperatively (IQR, 15.0-17.0), and nine patients (16.4%) underwent ipsilateral knee reintervention during follow-up, including revision ACL reconstruction and additional meniscal or lateral extra-articular procedures. CONCLUSION: In this prospective cohort of adolescents undergoing ACL reconstruction combined with modified Lemaire lateral extra-articular tenodesis, short-term subjective knee function was favorable, return to organized sport occurred in 96.4% of patients, and graft failure occurred in 9.1%. LEVEL OF EVIDENCE: Level IV, therapeutic case series.