Background:

Treatment of anterior cruciate ligament (ACL) injuries in the adolescent population continues to be complicated by an unacceptably high rate of secondary ACL injury.

Purpose:

To describe the failure rate and outcomes after a hybrid pediatric ACL reconstruction (ACLR) employing transphyseal hamstring (TPH) autograft combined with an extra-articular technique using an iliotibial band (ITB) autograft.

Study Design:

Case series; Level of evidence, 4.

Methods:

Consecutive patients undergoing combined TPH-ITB ACLR between January 2012 and April 2017 with a minimum 2-year follow-up were reviewed. With the goal of decreasing ACL graft injury in this high-risk group, this technique employed anteromedial portal drilling for TPH with an extraosseous femoral ITB technique and intra-articular TPH-ITB grafts fixed within the tibial bone tunnel. Demographics, bone age, standing alignment radiograph for growth and mechanical axis grade, return to sport, graft failure, and patient-reported outcome measures were analyzed.

Results:

A total of 61 knees in 60 adolescents underwent the combined TPH-ITB ACLR, with 57 knees (93.4%) meeting inclusion criteria with a mean follow-up of 38.5 months (range, 24-78 months). Only 3 of 57 knees (5.3%) sustained ACL reinjury. The mean age was 13.0 years (range, 11-16 years) with 36 male patients (mean bone age, 14.2 years) and 21 female patients (mean bone age, 13.3 years), and 91% of patients (52 of 57) returned to sport. Participants demonstrated a high functional level at final follow-up, with a mean score of 91.2 (range, 46.7-100) on the Pediatric International Knee Documentation Committee (Pedi-IKDC) Subjective Knee Evaluation Form and mean score of 22.4 (range, 4-30) on the Pediatric Functional Activity Brief Scale (Pedi-FABS). To critically assess growth, a cohort with ≥18 months of growth remaining at surgery was evaluated at maturity. No difference was seen in mean operative and nonoperative leg growth (49.7 mm and 49.8 mm). Although no family reported cosmetic or functional alignment or length concerns, 1 of 18 (5.5%) had a final limb length discrepancy >10 mm (12 mm) and a perioperative alignment difference (0-Grade II valgus).

Conclusion:

Combined TPH-ITB ACLR in adolescents resulted in high activity levels (Pedi-FABS, 22.4; median, 25) and a low (5.3%) graft failure rate at a mean 38.5 months.

中文翻译：

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联合经phy动脉和外侧关节外侧小儿前十字韧带重建术：一种减少ACL损伤同时允许生长的新技术。

背景：

在青少年人群中，前十字韧带（ACL）损伤的治疗继续由于二次ACL继发性损伤的高发生率而变得复杂。

目的：

要描述失败率和失败率和混合后的小儿ACL重建（ACLR）采用employing骨phy绳肌（TPH）自体移植结合关节外技术使用ili胫束带（ITB）自体移植后的失败率和结果。

学习规划：

案例系列；证据水平4。

方法：

回顾性分析了2012年1月至2017年4月间接受TPH-ITB ACLR联合治疗并连续至少2年随访的连续患者。为了减少这一高危人群的ACL移植物损伤，该技术采用了股骨外ITB技术和固定在胫骨骨隧道内的关节内TPH-ITB移植物进行TPH的前内侧门钻孔。分析了人口统计学，骨龄，站立式X线片的生长情况和机械轴等级，运动恢复，移植失败以及患者报告的结局指标。

结果：

TPH-ITB ACLR合并60例青少年共61膝，符合纳入标准的57膝（93.4％），平均随访38.5个月（24-78个月）。57个膝盖中只有3个（5.3％）遭受了ACL再损伤。平均年龄为13.0岁（范围11-16岁），其中36例男性患者（平均骨龄，14.2岁）和21例女性患者（平均骨龄，13.3岁），并且91％的患者（57个中的52个）返回运动。参与者在最终随访中表现出较高的功能水平，在儿科国际膝盖文献委员会（Pedi-IKDC）主观膝盖评估表上的平均分数为91.2（范围46.7-100），平均分数为22.4（范围4） -30）。为了严格评估增长，评估了在手术中剩余≥18个月生长的队列。术中和非术中平均腿长无差异（49.7 mm和49.8 mm）。尽管没有一家人报告有美容或功能性对准或长度方面的问题，但18个患者中有1个（5.5％）的最终肢体长度差异> 10 mm（12 mm），并且围手术期存在对准差异（0级II外翻）。

结论：

在青少年中联合使用TPH-ITB ACLR可导致较高的活动水平（Pedi-FABS，22.4；中位数，25），平均38.5个月的移植失败率低（5.3％）。