II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Hospital Las Higueras, Talcahuano, Concepción, Región del Bío Bío, Chile.
Am J Sports Med. 2019 Feb;47(2):285-295. doi: 10.1177/0363546518823544. Epub 2019 Jan 18.
Tibiofemoral anatomic parameters, such as tibial slope, femoral condyle shape, and anterior tibial subluxation, have been suggested to increase the risk of anterior cruciate ligament (ACL) reconstruction failure. However, such features have never been assessed among patients experiencing multiple failures of ACL reconstruction.
To compare the knee anatomic features of patients experiencing a single failure of ACL reconstruction with those experiencing multiple failures or with intact ACL reconstruction.
Case-control study; Level of evidence, 3.
Twenty-six patients who experienced failure of revision ACL reconstruction were included in the multiple-failure group. These patients were matched to a group of 25 patients with failure of primary ACL reconstruction and to a control group of 40 patients who underwent primary ACL reconstruction with no failure at a minimum follow-up of 24 months. On magnetic resonance imaging (MRI), the following parameters were evaluated: ratio between the height and depth of the lateral and medial femoral condyles, the lateral and medial tibial plateau slopes, and anterior subluxation of the lateral and medial tibial plateaus with respect to the femoral condyle. The presence of a meniscal lesion during each procedure was evaluated as well. Anatomic, demographic, and surgical characteristics were compared among the 3 groups.
The patients in the multiple-failure group had significantly higher values of lateral tibial plateau slope ( P < .001), medial tibial plateau slope ( P < .001), lateral tibial plateau subluxation ( P < .001), medial tibial plateau subluxation ( P < .001), and lateral femoral condyle height/depth ratio ( P = .038) as compared with the control group and the failed ACL reconstruction group. Moreover, a significant direct correlation was found between posterior tibial slope and anterior tibial subluxation for the lateral ( r = 0.325, P = .017) and medial ( r = 0.421, P < .001) compartments. An increased anterior tibial subluxation of 2 to 3 mm was present in patients with a meniscal defect at the time of the MRI as compared with patients who had an intact meniscus for both the lateral and the medial compartments.
A steep posterior tibial slope and an increased depth of the lateral femoral condyle represent a common finding among patients who experience multiple ACL failures. Moreover, higher values of anterior subluxation were found among patients with repeated failure and those with a medial or lateral meniscal defect.
胫骨倾斜度、股骨髁形状和胫骨前侧半脱位等胫股解剖参数已被认为会增加前交叉韧带（ACL）重建失败的风险。然而，这些特征从未在经历多次 ACL 重建失败的患者中进行过评估。
比较 ACL 重建单次失败患者与多次失败患者或 ACL 重建未失败患者的膝关节解剖特征。
病例对照研究；证据水平，3 级。
将 26 例经历 ACL 翻修重建失败的患者纳入多次失败组。这些患者与 25 例初次 ACL 重建失败的患者和 40 例初次 ACL 重建未失败且随访至少 24 个月的患者进行匹配。在磁共振成像（MRI）上，评估以下参数：外侧和内侧股骨髁的高度与深度之比、外侧和内侧胫骨平台斜率以及相对于股骨髁的外侧和内侧胫骨平台的前侧半脱位。还评估了每次手术中半月板损伤的情况。比较了 3 组之间的解剖、人口统计学和手术特征。
多次失败组患者的外侧胫骨平台斜率（P <.001）、内侧胫骨平台斜率（P <.001）、外侧胫骨平台前侧半脱位（P <.001）、内侧胫骨平台前侧半脱位（P <.001）和外侧股骨髁高度/深度比值（P =.038）明显高于对照组和 ACL 重建失败组。此外，还发现后胫骨斜率与外侧（r = 0.325，P =.017）和内侧（r = 0.421，P <.001）胫骨平台前侧半脱位之间存在显著的直接相关性。与内侧和外侧半月板完整的患者相比，MRI 时存在半月板损伤的患者，其胫骨前侧半脱位增加了 2 到 3 毫米。
后胫骨斜率陡峭和外侧股骨髁深度增加是多次 ACL 失败患者的常见表现。此外，在反复失败和存在内侧或外侧半月板损伤的患者中，发现前侧半脱位的数值更高。
