Jaecker Vera, Drouven Sabrina, Naendrup Jan-Hendrik, Kanakamedala Ajay C, Pfeiffer Thomas, Shafizadeh Sven
Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany.
University of Pittsburgh Medical Center, 3200 S Water Street, Pittsburgh, PA, 15203, USA.
Arch Orthop Trauma Surg. 2018 Oct;138(10):1423-1431. doi: 10.1007/s00402-018-2968-z. Epub 2018 May 28.
To analyze the contribution of increased lateral (LTPS) and medial tibial slopes (MTPS) as independent risk factors of graft failure following anterior cruciate ligament (ACL) reconstruction.
Fifty-seven patients with graft failure after ACL reconstruction who underwent revision surgery between 2009 and 2014 were enrolled and matched to a control group of 69 patients with primary anatomic successful ACL reconstruction. Patients were matched based on age, sex, date of primary surgery and graft type. LTPS and MTPS were measured on MRI in a blinded fashion. Tibial and femoral tunnel positions were determined on CT scans. Independent t test was used to compare the MTPS and LTPS between subgroups. Risks of graft failure associated with an increasing MTPS and LTPS were analyzed using binary logistic analysis.
The means of LTPS (7.3°) and MTPS (6.7°) in the graft failure group were found to be significantly greater than in the control group (4.6° and 4.1°, respectively; p = < 0.001). Non-anatomic and anatomic tunnel positions were found in 42 cases (73.7%) and 15 cases (26.3%), respectively. There were no significant differences in MTPS or LTPS between patients with anatomic and non-anatomic tunnel positions within the graft failure group. An increase of the MTPS of 1° was associated with an 1.24 times increased likelihood of exhibiting graft failure [95% CI 1.07-1.43] (p = 0.003) and an increase of the LTPS of 1° was associated with an 1.17 times increased likelihood of exhibiting graft failure [95% CI 1.04-1.31] (p = 0.009). The increased risk was most evident in patients with a lateral tibial posterior slope of ≥ 10°.
Increased LTPS and MTPS are independent risk factors for graft failure following ACL reconstruction regardless whether tunnel position is anatomic or non-anatomic. This information may be helpful to clinicians when considering slope correction in selected revision ACL reconstruction procedures.
分析外侧胫骨平台斜率（LTPS）增加和内侧胫骨斜率（MTPS）增加作为前交叉韧带（ACL）重建术后移植物失败的独立危险因素的作用。
纳入2009年至2014年间接受翻修手术的57例ACL重建术后移植物失败患者，并与69例初次解剖学成功的ACL重建患者的对照组进行匹配。根据年龄、性别、初次手术日期和移植物类型对患者进行匹配。以盲法在MRI上测量LTPS和MTPS。在CT扫描上确定胫骨和股骨隧道位置。采用独立t检验比较亚组之间的MTPS和LTPS。使用二元逻辑分析分析与MTPS和LTPS增加相关的移植物失败风险。
发现移植物失败组的LTPS（7.3°）和MTPS（6.7°）平均值显著高于对照组（分别为4.6°和4.1°；p < 0.001）。分别在42例（73.7%）和15例（26.3%）中发现非解剖学和解剖学隧道位置。移植物失败组中解剖学和非解剖学隧道位置的患者之间的MTPS或LTPS无显著差异。MTPS增加1°与移植物失败可能性增加1.24倍相关[95%置信区间1.07 - 1.43]（p = 0.003），LTPS增加1°与移植物失败可能性增加1.17倍相关[95%置信区间1.04 - 1.31]（p = 0.009）。风险增加在胫骨后外侧斜率≥10°的患者中最为明显。
无论隧道位置是解剖学的还是非解剖学的，LTPS和MTPS增加都是ACL重建术后移植物失败的独立危险因素。在考虑特定的翻修ACL重建手术中的斜率矫正时，这些信息可能对临床医生有帮助。
