Techniques chirurgicales et autogreffes en reconstruction du ligament croisé antérieur pédiatrique
Bibliographic record
Abstract
La prévalence des ruptures du ligament croisé antérieur (LCA) en pédiatrie est en augmentation constante, tout comme le recours à leur prise en charge chirurgicale. Cette population pose des défis spécifiques, notamment le risque d’impact du traitement chirurgical sur les plaques de croissance, tandis que l’approche conservatrice expose à un risque accru de lésions cartilagineuses et méniscales liées à l’instabilité articulaire persistante. Plusieurs techniques chirurgicales sont disponibles : transphysaires, épiphysaires et mixtes, le choix étant guidé par le potentiel de croissance restant et le choix du chirurgien. Divers types d’autogreffes peuvent également être utilisés : les ischiojambiers, le tendon rotulien, le tendon quadricipital et la bandelette ilio-tibiale, chacune présentant des avantages et des inconvénients spécifiques. Les chirurgiens orthopédiques pédiatriques doivent maîtriser ces différentes techniques afin d’offrir un traitement personnalisé, optimisant à la fois la stabilité articulaire et le potentiel de croissance. L’objectif de cette revue narrative était de synthétiser les connaissances actuelles sur les techniques chirurgicales et les options de greffe disponibles lors d’une reconstruction du LCA en pédiatrie. The prevalence of pediatric anterior cruciate ligament (ACL) tears is constantly rising, leading to a similar increase in reconstruction surgeries. This population is associated with specific treatment challenges. When it comes to surgical management there is a risk of growth disturbances, while conservative management increases the risk of damage to the cartilage and meniscus associated with persistent joint instability. Several surgical techniques are possible: transphyseal, epiphyseal and mixed, the final choice depending on the remaining possible growth and surgeon discretion. The choice of autograft that can be used is also varied: hamstring, patellar tendon, quadriceps tendon, and iliotibial band, each with its specific advantages and drawbacks. Pediatric orthopedic surgeons must master these different techniques to offer customized treatment, optimizing both joint stability and growth potential. The aim of this narrative review was to provide a synthesis of current knowledge on the available surgical techniques and graft options for pediatric ACL reconstruction.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.010 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".