Transphyseal anterior cruciate ligament reconstruction using living parental donor hamstring graft: excellent clinical results at 2 years in a cohort of 100 patients.

Autor: Ghosh K; North Sydney Orthopaedic and Sports Medicine Centre, The Mater Clinic, Suite 2, 3 Gillies St., Wollstonecraft, NSW, 2065, Australia., Salmon LJ; North Sydney Orthopaedic and Sports Medicine Centre, The Mater Clinic, Suite 2, 3 Gillies St., Wollstonecraft, NSW, 2065, Australia. lsalmon@nsosmc.com.au., Heath E; North Sydney Orthopaedic and Sports Medicine Centre, The Mater Clinic, Suite 2, 3 Gillies St., Wollstonecraft, NSW, 2065, Australia., Pinczewski LA; North Sydney Orthopaedic and Sports Medicine Centre, The Mater Clinic, Suite 2, 3 Gillies St., Wollstonecraft, NSW, 2065, Australia.; University of Notre Dame, Sydney, Australia., Roe JP; North Sydney Orthopaedic and Sports Medicine Centre, The Mater Clinic, Suite 2, 3 Gillies St., Wollstonecraft, NSW, 2065, Australia.
Jazyk: angličtina
Zdroj: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA [Knee Surg Sports Traumatol Arthrosc] 2020 Aug; Vol. 28 (8), pp. 2511-2518. Date of Electronic Publication: 2020 Jan 30.
DOI: 10.1007/s00167-019-05842-3
Abstrakt: Purpose: To determine outcomes of transphyseal ACL reconstruction using a living parental hamstring tendon allograft in a consecutive series of 100 children.
Methods: One hundred consecutive juveniles undergoing ACL reconstruction with a living parental hamstring allograft were recruited prospectively and reviewed 2 years after ACL reconstruction with IKDC Knee Ligament Evaluation, and KT1000 instrumented laxity testing. Skeletally immature participants obtained annual radiographs until skeletal maturity, and long leg alignment radiographs at 2 years. Radiographic Posterior tibial slope was recorded.
Results: Of 100 juveniles, the median age was 14 years (range 8-16) and 68% male. At surgery, 30 juveniles were graded Tanner 1 or 2, 21 were Tanner 3 and 49 were Tanner 4 or 5. There were no cases of iatrogenic physeal injury or leg length discrepancy on long leg radiographs at 2 years, despite a median increase in height of 8 cm. Twelve patients had an ACL graft rupture and 9 had a contralateral ACL injury. Of those without further ACL injury, 82% returned to competitive sports, IKDC ligament evaluation was normal in 52% and nearly normal in 48%. The median side to side difference on manual maximum testing with the KT1000 was 2 mm (range - 1 to 5). A radiographic PTS of 12° or more was observed in 49%.
Conclusions: ACL reconstruction in the juvenile with living parental hamstring tendon allograft is a viable procedure associated with excellent clinical stability, patient-reported outcomes and return to sport over 2 years. Further ACL injury to the reconstructed and the contralateral knee remains a significant risk, with identical prevalence observed between the reconstructed and contralateral ACL between 12 and 24 months after surgery.
Level of Evidence: III (Cohort Study).
Databáze: MEDLINE
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