Sonnery-Cottet Bertrand, Mogos Stefan, Thaunat Mathieu, Archbold Pooler, Fayard Jean-Marie, Freychet Benjamin, Clechet Julien, Chambat Pierre
Centre Orthopédique Santy and Hôpital Privé Jean Mermoz, Lyon, France
Centre Orthopédique Santy and Hôpital Privé Jean Mermoz, Lyon, France.
Am J Sports Med. 2014 Aug;42(8):1873-80. doi: 10.1177/0363546514534938. Epub 2014 May 28.
Physicians should consider an increased posterior tibial slope (PTS) as a risk factor for graft failure when proposing anterior cruciate ligament (ACL) re-revision.
To describe the surgical technique of combined ACL revision and proximal tibial anterior closing wedge osteotomy and to evaluate its clinical outcome in cases of recurrent graft failure with associated increased tibial slope.
Case series; Level of evidence, 4.
Between 2008 and 2010, 5 combined ACL re-revisions with proximal tibial anterior closing wedge osteotomy were retrospectively evaluated after a mean 31.6 months' follow-up (range, 23-45 months). All patients reported subjective knee instability preoperatively and demonstrated increased laxity on physical examination. Intrinsic risk factors for graft failure (excessive tibial slope) were identified in all cases. Preoperative and postoperative functional assessments included the International Knee Documentation Committee (IKDC) score along with the Lysholm score and Tegner activity scale.
The mean Lysholm score was 46.2 preoperatively (range, 26-69) and 87.8 (range, 60-100) postoperatively. The mean IKDC subjective score was 39.5 (range, 21.8-64.4) before surgery and 79.1 (range, 48.3-98.9) at the last follow-up. The mean Tegner activity score was 7.4 (range, 5-9) before the latest ACL injury and 7.2 (range, 5-9) at the last follow-up. The mean PTS was 13.6° (range, 13°-14°) preoperatively and 9.2° (range, 8°-10°) postoperatively (P = .0005). The mean differential anterior laxity was 10.4 mm (range, 8-14 mm), and this significantly decreased to 2.8 mm (range, 2-4 mm) at the last follow-up. Using the Kellgren-Lawrence classification to evaluate the presence of arthritis, 1 patient was grade 1, 3 patients were grade 2, and 1 patient was grade 3.
Combined ACL re-revision with proximal tibial anterior closing wedge osteotomy restores knee stability and function with satisfactory clinical outcomes in patients who experience recurrent ACL ruptures with an associated increased PTS.
在考虑进行前交叉韧带（ACL）翻修手术时，医生应将胫骨后倾坡度（PTS）增加视为移植物失败的一个风险因素。
描述联合ACL翻修与胫骨近端前侧闭合楔形截骨术的手术技术，并评估其在伴有胫骨坡度增加的复发性移植物失败病例中的临床疗效。
病例系列；证据等级，4级。
在2008年至2010年期间，对5例行联合ACL翻修与胫骨近端前侧闭合楔形截骨术的患者进行回顾性评估，平均随访31.6个月（范围23 - 45个月）。所有患者术前均自述膝关节不稳定，体格检查显示膝关节松弛增加。所有病例均确定了移植物失败的内在风险因素（胫骨坡度过大）。术前和术后功能评估包括国际膝关节文献委员会（IKDC）评分、Lysholm评分和Tegner活动量表。
术前Lysholm评分平均为46.2（范围26 - 69），术后为87.8（范围60 - 100）。术前IKDC主观评分为39.5（范围21.8 - 64.4），最后一次随访时为79.1（范围48.3 - 98.9）。最新一次ACL损伤前Tegner活动评分平均为7.4（范围5 - 9），最后一次随访时为7.2（范围5 - 9）。术前PTS平均为13.6°（范围13° - 14°），术后为9.2°（范围8° - 10°）（P = .0005）。平均前向松弛度术前为10.4 mm（范围8 - 14 mm），最后一次随访时显著降至2.8 mm（范围2 - 4 mm）。采用Kellgren - Lawrence分类法评估关节炎情况，1例为1级，3例为2级，1例为3级。
对于经历复发性ACL断裂且伴有PTS增加的患者，联合ACL翻修与胫骨近端前侧闭合楔形截骨术可恢复膝关节稳定性和功能，临床疗效满意。
