儿童人群ACL重建后腘绳肌腱移植物重塑较成人缓慢。
简介
该项前瞻性对照研究纳入52例儿童和59例成人，均在ACL重建中采用四折腘绳肌腱自体移植物，术后1年通过MRI信号噪声比（SNQ）和Howell评分评估移植物重塑情况。结果显示儿童SNQ显著高于成人（5.1 vs 1.5），移植物成熟度更低，但胫骨骨道扩大比例和患者主观评分两组相似。提示儿童ACL重建后移植物生物学重塑较成人缓慢，或与年轻运动员再损伤率较高有关…
英文摘要
PURPOSE: Anterior cruciate ligament (ACL) injuries are increasing in children and adolescents and reconstruction (ACLR) is now frequently performed in this population. Paediatric patients remain at higher risk of reinjury, possibly due to delayed graft remodelling. The current study aims to compare magnetic resonance imaging (MRI)-based graft remodelling between paediatric and adult populations at 1 year postoperatively. METHODS: We conducted a single-centre comparative pilot study including a prospectively collected cohort of 52 paediatric and 59 adult patients undergoing ACLR with a semitendinosus autograft folded in four (ST4) without additional lateral extra-articular tenodesis (LET). MRI was performed at 12 months postoperatively. Graft maturation was assessed using the signal-to-noise quotient (SNQ) and Howell scores. Tibial tunnel widening (TTW) and patient-reported outcome measures (PROMs) were also collected. RESULTS: The mean adjusted SNQ was significantly higher (p < 0.001) in paediatric patients (5.1; 95% confidence interval [CI] [4.3-5.9]) than in adults (1.5; 95% CI [0.9-2.2]), indicating slower remodelling. The Howell classification confirmed less mature grafts in children, with a predominance of Grade II. TTW was observed in similar proportions in both groups. PROMs were favourable and comparable in both groups. One paediatric patient experienced a graft rupture at 6 months, following premature return to pivoting sport. CONCLUSION: At 1-year post-ACLR, paediatric patients show delayed graft remodelling compared to adults. This slower biological incorporation may contribute to higher reinjury rates in young athletes and supports the need for prolonged rehabilitation and careful return to high-risk sports. LEVEL OF EVIDENCE: Level II.