背景:前交叉韧带(ACL)撕裂在骨骼未成熟患者中越来越常见。在骨骼未成熟患者中比较全-骨-骨-骨-骨-骨-骨-骨-骨重建ACL的结果的证据是有限的,当前的文献可以从全面的系统综述中受益。本研究比较了骨骼未成熟患者的全phy骨与经phy骨ACL重建。感兴趣的结果是比较关节松弛,患者报告结果测量(PROMs),回到运动,和并发症。
方法:本研究是根据2020年系统评价和荟萃分析(PRISMA)报告优选项目进行的。2023年11月,访问了以下数据库:PubMed,WebofScience,谷歌学者,和Embase。在数据库搜索中没有使用其他过滤器。访问了所有研究骨骼未成熟患者ACL重建的临床研究。只有明确说明手术技术(全-或跨-骨phy)的文章才有资格。仅包括至少6个月随访的文章。只有明确指出在患有开放性physis的儿童中进行手术的文章才有资格。
结果:收集了1489例患者(1493例手术)的数据,其中32%(1489例患者中的490例)为女性。平均随访时间为46.6个月。患者的平均年龄为12.7岁。关节松弛度无差异(表3):正枢轴移位(P=0.4),Lachman检验阳性(P=0.3),和平均关节松弛度(P=0.1)。PROM中没有发现差异(表4):国际膝关节文献委员会(IKDC)(P=0.3),Lysholm(P=0.4),和Tegner(P=0.7)。经骨phy技术与无法恢复运动的患者比率更高(1%对7%,P=0.0001),并且恢复运动的时间更长(7.7对8.6个月,P=0.01)。尽管经骨phy技术与较低的运动回报率有关,差异无统计学意义(P=0.8).在降低他们的联赛或体育活动水平的患者比率(P=0.6)或恢复到以前的联赛或体育活动水平的患者比率(P=0.7)方面没有差异。并发症发生率无差异:再撕裂(P=0.8),再手术(P=0.7),松弛度增加(P=0.9),和持续性不稳定感(P=0.3)。
结论:在骨骼未成熟患者中,与全-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-骨-证据等级三级,系统回顾。
BACKGROUND: Anterior cruciate ligament (ACL) tears in skeletally immature patients are increasingly common. Evidence comparing the outcomes of all-epiphyseal versus trans-epiphyseal ACL reconstruction in skeletally immature patients is limited, and the current literature could benefit from a comprehensive systematic
review. The present study compared all-epiphyseal versus trans-epiphyseal ACL reconstruction in skeletally immature patients. The outcomes of interest were to compare joint laxity, patient-reported outcome measures (PROMs), return to sport, and complications.
METHODS: This study was conducted according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In November 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. No additional filters were used in the database search. All the clinical studies investigating ACL reconstruction in skeletally immature patients were accessed. Only articles that clearly stated the surgical technique (all- or trans-epiphyseal) were eligible. Only articles with a minimum of 6 months of follow-up were included. Only articles that clearly stated that surgeries were conducted in children with open physis were eligible.
RESULTS: Data from 1489 patients (1493 procedures) were collected, of which 32% (490 of 1489 patients) were female. The mean length of follow-up was 46.6 months. The mean age of the patients was 12.7 years. No difference was found in joint laxity (Table 3): positive pivot shift (P = 0.4), positive Lachman test (P = 0.3), and mean arthrometer laxity (P = 0.1). No difference was found in PROMs (Table 4): International Knee Documentation Committee (IKDC) (P = 0.3), Lysholm (P = 0.4), and Tegner (P = 0.7). The trans-epiphyseal technique was associated with a greater rate of patients unable to return to sports (1% versus 7%, P = 0.0001) and with a longer time to return to sports (7.7 versus 8.6 months, P = 0.01). Though the trans-epiphyseal technique was associated with a lower rate of return to sport, this difference was not statistically significant (P = 0.8). No difference was evidenced in the rate of patients who had reduced their league or level of sports activity (P = 0.6) or in the rate of patients who had returned to their previous league or level of sports activity (P = 0.7). No difference was found in the rate of complication: re-tear (P = 0.8), reoperation (P = 0.7), increased laxity (P = 0.9), and persistent instability sensation (P = 0.3).
CONCLUSIONS: Trans-epiphyseal ACL reconstruction was associated with a greater rate of patients unable to return to sport and with a longer time to return to sport compared with the all-epiphyseal technique in skeletally immature patients. Level of evidence Level III, systematic
review.