骨骺保留ACL重建中的生长干扰：三种ACLR技术在骨骼未成熟患者中的比较
简介
本研究比较了骨骼未成熟患者中三种ACL重建技术（经骺板、关节内骺板外和部分骨骺内技术）的功能结果、骺板干扰率、移植物失败率和再手术率。对87例患者（平均年龄13-15岁）的分析显示，部分骨骺内技术并发症率最高（50%），主要为关节僵硬和ACL再撕裂。所有技术均观察到可比的成角生长干扰（4.6%患者出现3°-5°外翻），无肢体不等长或生长停滞。关键发现是，在恰…
英文摘要
BACKGROUND: In pediatric anterior cruciate ligament reconstruction (ACLR), there exists a potential to injure the open physis in skeletally immature patients and cause growth disturbance. Thus, there is a need to determine the optimal ACLR technique for this population. PURPOSE: To evaluate the functional outcomes and rates of physeal disturbance, graft failure, and reoperation after transphyseal and physeal-protecting techniques-including extraphyseal intra-articular and partial epiphyseal ACLR-within the skeletally immature population. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients who underwent primary ACLR from June 2018 to April 2023 at a tertiary pediatric hospital were identified. The exclusion criteria included skeletal maturity based on preoperative magnetic resonance imaging, concomitant multi-ligamentous injury, excluding medial collateral ligament sprain that did not require surgical intervention, and <6 months of follow-up. Descriptive, injury, and surgical data; clinical outcomes; and complications were analyzed using the chi-square and Kruskal-Wallis tests. Growth disturbance was assessed using pre- and postoperative standing hip-to-ankle films. RESULTS: A total of 87 patients met the study inclusion criteria. A total of 41 (47.1%) patients underwent transphyseal (mean age, 15.2 ± 0.9), 34 (39.1%) underwent extraphyseal intra-articular (12.9 ± 1.7), and 12 (13.8%) underwent partial epiphyseal (14.6 ± 1.2) ACLR. The transphyseal group was significantly older in chronological and skeletal age (P < .001). Autograft types varied significantly across cohorts (P < .001). The partial epiphyseal technique had the highest rate of complications (50%; P = .009), most commonly stiffness (n = 2) and ACL retear (n = 2). Four (4.6%) patients experienced unilateral growth disturbance, with 1 in the extraphyseal intra-articular group. Angular growth disturbance ranged from 3° to 5º of valgus. There were no cases of leg length discrepancy or growth arrest. CONCLUSION: Comparable angular growth disturbance and retear rates were observed across all 3 ACLR techniques in skeletally immature patients, suggesting acceptable outcomes with appropriate surgical technique.