Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France.
ReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2019 Feb;27(2):564-572. doi: 10.1007/s00167-018-5180-3. Epub 2018 Sep 29.
The aim of this study was to determine patient and anatomic factors that influence anteroposterior and rotational laxity in knees with ACL tears. Based on the findings of biomechanical studies, we hypothesized that static and dynamic anterior tibial translation (ATT) as well as positive pivot shift would increase with female gender, tibial slope, and meniscal tears.
The authors prospectively collected preoperative data and intraoperative findings of 417 patients that underwent ACL reconstruction. The exclusion criteria were: revision ACL procedures (n = 53), other surgical antecedents (n = 27), prior osteotomies (n = 7) or concomitant ligament tears on the ipsilateral knee (n = 34), and history of ACL tears in the contralateral knee (n = 45), leaving a study cohort of 251 patients. Their preoperative anteroposterior knee laxity was assessed objectively using 'static' monopodal weight-bearing radiographs and 'dynamic' instrumented differential measurements of ATT. Rotational laxity was assessed subjectively using the pivot shift test.
Multivariable regression showed that static ATT increases only with tibial slope (β = 0.30; p < 0.001), but dynamic ATT increases with tibial slope (β = 0.19; p = 0.041), medial meniscal tears (β = 1.27; p = 0.007), complete ACL tears (β = 2.06; p < 0.001), and to decrease with age (β = - 0.09; p < 0.001). Multivariable regression also indicated that high-grade pivot shift decreases with age (OR 0.94; p < 0.001) and for women (OR 0.25; p < 0.001), and to be higher for knees with complete ACL tears (OR 3.04; p = 0.002) or medial meniscal tears (OR 2.28; p = 0.010).
Contrary to expectations based on biomechanical studies, static ATT was only affected by high posterior tibial slope, while dynamic ATT was affected by both high posterior tibial slopes and medial meniscal tears, but not by gender or lateral meniscal tears. Likewise, pivot shift was affected by gender and medial meniscal tears, but not lateral meniscal tears or posterior tibial slope. These findings are relevant to guide surgeons in optimizing their surgical procedures, such as conserving the menisci when possible, and rehabilitation protocols, by delaying full weight-bearing and return to sports in patients with anatomic and lesional risk factors.
Cohort study, Level IV.
本研究旨在确定影响 ACL 撕裂膝关节前后向和旋转松弛的患者和解剖因素。基于生物力学研究的结果，我们假设静态和动态胫骨前移（ATT）以及阳性枢轴转移试验（Pivot Shift）会随着女性性别、胫骨倾斜度和半月板撕裂而增加。
作者前瞻性地收集了 417 例接受 ACL 重建的患者的术前数据和术中发现。排除标准为：ACL 翻修手术（n=53）、其他手术史（n=27）、既往截骨术（n=7）或同侧膝关节同时发生其他韧带撕裂（n=34），以及对侧膝关节 ACL 撕裂史（n=45），因此研究队列中有 251 例患者。使用“静态”单足负重放射学检查和“动态”仪器测量 ATT 的差异测量来客观评估术前膝关节前后向松弛度。使用枢轴转移试验主观评估旋转松弛度。
多变量回归显示，仅胫骨倾斜度增加静态 ATT（β=0.30；p<0.001），但动态 ATT 增加与胫骨倾斜度（β=0.19；p=0.041）、内侧半月板撕裂（β=1.27；p=0.007）、完全 ACL 撕裂（β=2.06；p<0.001）相关，而与年龄呈负相关（β=-0.09；p<0.001）。多变量回归还表明，高等级枢轴转移试验随着年龄的增长（OR 0.94；p<0.001）和女性（OR 0.25；p<0.001）而降低，并且在完全 ACL 撕裂（OR 3.04；p=0.002）或内侧半月板撕裂（OR 2.28；p=0.010）的膝关节中更高。
与基于生物力学研究的预期相反，静态 ATT 仅受高胫骨后倾影响，而动态 ATT 受高胫骨后倾和内侧半月板撕裂影响，但不受性别或外侧半月板撕裂影响。同样，枢轴转移试验受性别和内侧半月板撕裂影响，但不受外侧半月板撕裂或胫骨后倾影响。这些发现对于指导外科医生优化手术程序具有重要意义，例如在可能的情况下保留半月板，以及根据解剖和病变危险因素，推迟完全负重和重返运动的康复方案。
队列研究，IV 级。
