预测儿科和青少年患者经骺前十字韧带重建术后再次损伤的移植物类型和直径

Q3 Medicine Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2024-10-01 DOI:10.1016/j.asmr.2024.100964

Luca Rigamonti M.D. , Nathaniel Bates Ph.D. , Nathan Schilaty Ph.D. , Bruce Levy M.D. , Todd Milbrandt M.D. , Marco Bigoni M.D. , Michael Stuart M.D. , Aaron J. Krych M.D.

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引用次数: 0

摘要

目的报告按韧带状态（开放、闭合、封闭）分类的前交叉韧带（ACL）移植物失败率，并分析哪些因素与前交叉韧带移植物失败的高风险相关。方法对 2000 年至 2018 年期间在一家机构接受经骨前交叉韧带重建术（ACLR）的 18 岁以下患者在 ACLR 术后至少 2 年进行复查。回顾了患者的人体测量学、手术技术和前交叉韧带移植失败的记录。随后根据假体状态（开放、闭合、封闭）对患者进行分层并进行分析。63.6%的病例采用了经胫骨技术。开放髋关节组仅使用了腘绳肌自体移植。65.9%的闭合髋关节患者和80.9%的闭合髋关节患者使用了髌腱自体移植物。总体移植失败率为13.2%，对侧前交叉韧带损伤率为11.0%。按韧带状态进行的 Kaplan-Maier 分析显示，前交叉韧带再损伤的免伤率存在差异（P < .001）。与闭合髋臼相比，开放髋臼增加了前交叉韧带再损伤的风险（危险比，5.2；P <.001）。闭合式髋关节的危险比更高，但无统计学意义（危险比为 2.6；P = .08）。腘绳肌移植物类型（P = .03）和较低的移植物直径（P = .04）与较高的前交叉韧带再损伤率有显著相关性（调整髋臼状态后）。再损伤率为13.2%。随着骨骼的成熟、髌腱自体移植物的使用以及移植物直径的增大，再损伤率会降低。

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Graft Type and Diameter Are Predictors of Reinjury After Transphyseal Anterior Cruciate Ligament Reconstruction in Pediatric and Adolescent Patients

Purpose

To report the rate of anterior cruciate ligament (ACL) graft failure by physis status (open, closing, closed) and to analyze which factors were associated with higher risk of ACL graft failure.

Methods

Patients younger than 18 years who underwent transphyseal ACL reconstruction (ACLR) between 2000 and 2018 at a single institution were reviewed at minimum 2 years after ACLR. Patient records were reviewed for anthropometrics, surgical techniques, and ACL graft failure. Patients were subsequently stratified based on physis status (open, closing, closed) and analyzed.

Results

A total of 272 patients (mean age of 15.4 ± 1.3 years) were assessed. The transtibial technique was used in 63.6% of cases. A hamstring autograft was used exclusively in the open physis group. A patellar tendon autograft was used in 65.9% of patients with a closing physis and 80.9% of patients with a closed physis. The overall graft failure rate was 13.2%, with a contralateral ACL injury rate of 11.0%. Kaplan-Maier analysis by physis status showed different injury free from ACL reinjury (P < .001). An open physis was associated with increased risk of ACL reinjury (hazard ratio, 5.2; P < .001) when compared to a closed physis. A closing physis presented a higher hazard ratio but was not statistically significant (hazard ratio, 2.6; P = .08). Hamstring graft type (P = .03) and lower graft diameter (P = .04) were significantly related to higher ACL reinjury after adjusting for physis status.

Conclusions

Transphyseal ACLR is a safe procedure in pediatric patients. The rate of reinjury was 13.2%. This rate decreases with skeletal maturity, use of patellar tendon autograft, and a larger graft diameter.