■多发性膝盖受伤(MLKI),在青少年中罕见,是具有挑战性的损伤,需要复杂的手术重建。历史上,非解剖重建与长时间的固定和不能恢复正常的膝关节生物力学有关,导致关节纤维化和移植物失败率高。
■描述接受单阶段解剖多韧带膝关节重建治疗的青少年患者的临床和患者报告结果(PRO)。
■案例系列;证据级别,4.
■对单中心回顾性研究进行了单中心回顾性研究,这些患者在2014年至2019年期间由一名外科医生使用单阶段解剖技术进行了MLKIs重建,具有保护的承重和早期运动范围。并发症被定义为感染,关节纤维化,深静脉血栓形成(DVT)或肺栓塞,和二次手术。PROs,包括国际膝关节文献委员会(Pedi-IKDC)的儿科版本和Tegner活动评分,在术后至少2年获得。
■包括30名患者(21名男性,9名女性;平均年龄,15.4年)。最常见的韧带重建类型是前交叉韧带(ACL)+腓侧副韧带(12例;40%)和ACL+内侧副韧带(9例;30%)。三名患者(10%)进行了二次手术,包括冲洗和肉芽肿清创术,分阶段的同种异体骨软骨移植到股骨外侧髁撞击骨折,ACL+腓侧副韧带重建2年后,修复与新损伤相关的内侧半月板撕裂和外侧股骨髁骨折。2例患者(7%)发生关节纤维化,1例患者(3%)发生DVT。术后平均37个月获得的PRO评分包括87的平均Pedi-IKDC(范围,52-92)和术后任何点的中位最高Tegner评分为9(范围,5-10).在受伤前是运动员的患者中,70%的人术后恢复到相同或更高的运动水平。
■使用单阶段解剖技术和早期活动范围在这一系列青少年中重建MLKI导致二次手术率较低,并发症少,良好的膝关节功能以及平均3年随访时的PRO评分。
UNASSIGNED: Multiligament knee injuries (MLKI), rare in adolescents, are challenging injuries that require complex surgical reconstruction. Historically, nonanatomic reconstructions have been associated with prolonged immobilization and failure to restore normal knee biomechanics, resulting in arthrofibrosis and high rates of graft failure.
UNASSIGNED: To describe the clinical and patient-reported outcomes (PROs) for adolescent patients treated with single-stage anatomic multiligament knee reconstruction.
UNASSIGNED: Case series; Level of evidence, 4.
UNASSIGNED: A single-center retrospective study was performed of patients ≤18 years old who underwent reconstruction of MLKIs by a single surgeon between 2014 and 2019 using a single-stage anatomic technique, with protected weightbearing and early range of motion. Complications were defined as infection, arthrofibrosis, deep vein thrombosis (DVT) or pulmonary embolus, and secondary surgery. PROs, including the pediatric version of the International Knee Documentation Committee (Pedi-IKDC) and the Tegner activity score, were obtained at a minimum of 2 years postoperatively.
UNASSIGNED: Included were 30 patients (21 male, 9 female; mean age, 15.4 years). The most common ligamentous reconstruction types were anterior cruciate ligament (ACL) + fibular collateral ligament (12 patients; 40%) and ACL + medial collateral ligament (9 patients; 30%). Three patients (10%) had secondary surgeries, including irrigation and debridement of a granuloma, a staged osteochondral allograft transplantation to a lateral femoral condyle impaction fracture, and repair of a medial meniscal tear and lateral femoral condyle fracture associated with new injuries 2 years after ACL + fibular collateral ligament reconstruction. Two patients (7%) developed arthrofibrosis and 1 patient (3%) developed DVT. PRO scores obtained at a mean of 37 months postoperatively included a mean Pedi-IKDC of 87 (range, 52-92) and a median highest Tegner score at any point postoperatively of 9 (range, 5-10). Of the patients who were athletes before their injury, 70% returned to the same or higher level of sport postoperatively.
UNASSIGNED: Reconstruction of MLKI in this series of adolescents with single-stage anatomic techniques and early range of motion resulted in low rates of secondary surgery, few complications, and good knee function as well as PRO scores at mean 3-year follow-up.