Tratamiento de la lesión del ligamento cruzado anterior en pacientes con fisis abiertas / Treatment of anterior cruciate ligament injury in patients with open physis

Contexto: las roturas del ligamento cruzado anterior (LCA) en pacientes con fisis abiertas representan el 3,3% de las roturas del LCA, En el tratamiento de las roturas intersticiales del LCA en pacientes con fisis abiertas existe controversia en la elección entre tratamiento conservador y tratamiento quirúrgico. Objetivo: analizar la reconstrucción del ligamento cruzado anterior LCA con fisis abierta en el Servicio de Ortopedia y Traumatología del Hospital de Especialidades FFAA No 1. Sujetos y métodos: estudio retrospectivo en pacientes sometidos a cirugía artroscópica para tratamiento de lesión del LCA con fisis abiertas, en el periodo enero 2012 y abril de 2015. En relación al tratamiento, se utilizó la técnica transfisaria completa (monotúnel); el injerto se fija al fémur con un endobotón y a la tibia con un tornillo de interferencia; el injerto fue obtenido del músculo semitendinoso. Resultados: fueron intervenidos 9 pacientes de sexo masculino, con edades entre 13 y 16 años, con lesiones del ligamento cruzado anterior en rodilla derecha (n=7, 78%) e izquierda (n=2, 22%); la ruptura del menisco es la lesión asociada más frecuente. Conclusión: las roturas del LCA con fisis abiertas son cada vez más frecuentes en la actualidad. La reconstrucción del LCA debe ser precoz para evitar lesiones condrales y meniscales. Se recomienda el tratamiento quirúrgico por los óptimos resultados clínicos y funcionales. (AU)

Background: anterior cruciate ligament (ACL) tears in open physis patients represent 3.3% of ACL tears. In the treatment of ACL interstitial tears in patients with open physis, there is controversy in the choice between conservative treatment and surgical treatment. Objective: to analyze the reconstruction of the anterior cruciate ligament ACL with open physis in the Orthopedics and Traumatology Service of the Specialty Hospital FFAA No 1. Subjects and methods: retrospective study in patients undergoing arthroscopic surgery for treatment of ACL injury with open physis, in the period January 2012 and April 2015. In relation to the treatment, the complete transfusion technique (monotunnel) was used; the graft is fixed to the femur with an endobotton and to the tibia with an interference screw; the graft was obtained from the semitendinous muscle. Results: were operated on 9 male patients, with ages between 13 and 16 years, with injuries of the anterior cruciate ligament in the right knee (n = 7, 78%) and left (n = 2, 22%); the rupture of the meniscus is the most common associated lesion. Conclusion: ACL tears with open physis are becoming more frequent today. The reconstruction of the ACL must be early to avoid chondral and meniscal lesions. Surgical treatment is recommended for optimal clinical and functional results. (AU)

Modified arthroscopic internal fixation of avulsion fracture of the anterior cruciate ligament from the tibial insertion site with cannulated screw and washer / 第三军医大学学报

Objective To evaluate more than 5-year follow-up outcome of avulsion fracture of the anterior cruciate ligament from the tibial insertion site in skeletally immature patients treated with modified arthroscopic internal fixation with cannulated screw and washer. Methods Thirty-nine patients with open physis were treated by modified arthroscopic internal fixation with cannulated screw and washer from March 2000 to November 2003. Regular X-ray plain films at AP and lateral views were conducted to detect the healing of avulsed fragments. Follow-up period of 31 patients was more than 5 years. Functional outcome before and after surgery was evaluated using the Lysholm Knee Score and the Tegner Activity Score. Angular deformity, or leg length discrepancy was assessed by clinical examination and anteroposterior-lateral radiographs of the knee. Instrumented knee laxity was performed using the KT-2000 arthrometer. Results Arthroscopic removal of implants was performed between 3 and 6 months postoperatively, when all fractures were revealed to have healed on X-ray films. No growth disturbance, angular deformation or knee instability was found in 31 patients during more than 5-year follow-up. The Lysholm score was improved from (19.2?14.8) (range 12-48) preoperatively to (98.5?3.1) (range 97-100) postoperatively, with significant statistical difference by the student-t test (t=18.395, P=0.000); The Tegner score was improved from (4.1?1.1) (range 3-5) preoperatively to (8.5?0.8) (range 7-9) postoperatively, with significant statistical difference by the student-t test (t=4.13, P=0.008). Physical examination showed Lachman test (+) in 14 of 31 patients. Instrumented knee laxity (KT-2000) showed manual-maximum side-to-side difference greater than 2 mm (range 2.1-3.8 mm) in 14 of 31 patients. Conclusion Modified arthroscopic internal fixation of avulsion fracture of the anterior cruciate ligament from the tibial insertion site with cannulated screw and washer in skeletally immature patients is a simple, safe, and effective ARIF procedure without growth disturbance.