骨骼成熟前2年内行经骺板ACL重建后冠状面与矢状面力线变化：PLUTO研究组结果
简介
这项前瞻性多中心队列研究（证据等级2）纳入91例剩余生长≤2年的骨骺未闭患者，均接受经骺板软组织自体移植物ACLR及干骺端固定，以患侧与健侧力线参数差值从术前到术后1年的变化（Δ2）评估，中位骨骼年龄14.0岁。队列整体MAD、aLDFA、mMPTA和LLD的Δ2中位值均较小，但28%患者MAD Δ2≥10 mm（73%转为外翻），17% aLDFA Δ2≥…
英文摘要
BACKGROUND: For patients with open physes approaching skeletal maturity, transphyseal anterior cruciate ligament reconstruction (ACLR) with soft tissue autograft and metaphyseal fixation is often preferred. Although iatrogenic physeal injury is rare, growth disturbances have been reported. This study sought to evaluate postoperative changes in lower extremity alignment 1 year after transphyseal ACLR in skeletally immature patients within 2 years of skeletal maturity. HYPOTHESIS: Transphyseal ACLR would not result in clinically significant changes in alignment. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: This was a prospective multicenter study of skeletally immature patients with ≤2 years of remaining growth who underwent primary transphyseal soft tissue autograft ACLR. The change in the difference in alignment parameters between involved and uninvolved extremities from preoperative assessment to 1 year postoperative was calculated (difference of differences = Δ2) to account for naturally occurring alignment changes during growth. Radiographic measurements included mechanical axis deviation (MAD), anatomic lateral distal femoral angle (aLDFA), mechanical medial proximal tibial angle (mMPTA), posterior tibial slope (PTS), and leg length discrepancy (LLD). RESULTS: A total of 91 patients (48 males) merited inclusion with a median skeletal age of 14.0 years. Reconstructions were performed with hamstring (46%) or quadriceps (54%) autograft. The cohort-wide median Δ2 values for MAD (2.9 mm), aLDFA (-1°), mMPTA (0°), and LLD (0.1 cm) were small. However, 28% of patients demonstrated a ≥10-mm Δ2 in MAD (73% into valgus), and Δ2 for aLDFA and mMPTA was ≥5° in 17% (73% into valgus) and 16% (43% into varus) of patients, respectively. One patient (1%) subsequently was recommended for intervention for growth disturbance at latest follow-up. CONCLUSION: This study of skeletally immature individuals with ≤22 years of growth remaining who underwent transphyseal ACLR with soft tissue autograft and metaphyseal fixation demonstrated minimal cohort-wide changes in alignment at 1 year postoperatively. However, a meaningful subset of patients (16%-28%) demonstrated clinically relevant changes in alignment, most commonly into valgus and decreased tibial slope. These findings warrant routine preoperative radiographic assessment and surveillance until skeletal maturity. Further study is needed to define thresholds for implant-mediated guided growth in patients with borderline valgus preoperatively who may be at risk of progressive deformity.