Gupta Arnav, Tejpal Tushar, Shanmugaraj Ajaykumar, Horner Nolan S, Simunovic Nicole, Duong Andrew, Ayeni Olufemi R
1Faculty of Health Sciences, McMaster University, Hamilton, Ontario Canada.
2Department of Surgery, Division of Orthopaedic Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St West, 4E15, Hamilton, Ontario L8N 3Z5 Canada.
HSS J. 2019 Jul;15(2):176-184. doi: 10.1007/s11420-018-9630-8. Epub 2018 Sep 24.
The incidence of primary anterior cruciate ligament reconstruction (ACLR) failure ranges from 10 to 20% in the USA. Many patient and surgical factors may lead to re-rupture after ACLR. Some authors have suggested that not correcting excessive posterior tibial slope may be a significant contributing factor to ACLR failure.
We sought to systematically review the literature on outcomes, indications, and complications in patients undergoing simultaneous high tibial osteotomy (HTO) and ACLR revision.
PubMed, Medline, and Embase were searched in February 2018 for articles addressing simultaneous HTO and ACLR revision in skeletally mature patients. Major orthopedic conferences were screened in duplicate to find gray literature. All studies were assessed using the Methodological Index for Non-Randomized Studies. Descriptive statistics are presented where applicable.
Seven studies satisfied inclusion. Seventy-seven patients underwent combined HTO and ACLR revision. The main indications were a posterior slope of more than 12° or severe varus malalignment. Graft types included hamstring tendon autograft (58.4%; 45) and quadriceps tendon graft (16.9%; 13). Mean delay between primary and revision surgery was 9 years. Rehabilitation protocol dictated return to running at 4 months and return to sport at 4 to 9 months. Visual analog scale pain scores reduced on average by 30 points. Subjective International Knee Documentation Committee, Tegner-Lysholm, and Tegner activity scores also improved. Fifty-eight percent (35/60) of patients showed osteoarthritis signs post-operatively. One patient (1.3%) received an arthroscopic arthrolysis of adhesions for stiffness. There were no reported incidences of graft re-rupture.
This systematic review found that the use of HTO for ACLR revision produces good post-operative functional outcomes, low complication rates, and no reported re-ruptures. The main indications for combined HTO with ACLR revision was a posterior slope of more than 12° or severe varus malalignment. Future studies with large sample sizes and long-term follow-up are required to corroborate these results.
在美国，初次前交叉韧带重建术（ACLR）失败的发生率为10%至20%。许多患者因素和手术因素可能导致ACLR术后再次断裂。一些作者认为，未矫正过度的胫骨后倾可能是ACLR失败的一个重要因素。
我们试图系统回顾关于同时进行高位胫骨截骨术（HTO）和ACLR翻修术患者的预后、适应证及并发症的文献。
2018年2月在PubMed、Medline和Embase数据库中检索关于骨骼成熟患者同时进行HTO和ACLR翻修术的文章。对主要骨科会议进行重复筛选以查找灰色文献。所有研究均使用非随机研究方法学指数进行评估。在适用的情况下进行描述性统计。
七项研究符合纳入标准。77例患者接受了HTO和ACLR联合翻修术。主要适应证为后倾超过12°或严重内翻畸形。移植物类型包括自体腘绳肌腱（58.4%；45例）和股四头肌肌腱移植物（16.9%；13例）。初次手术与翻修手术之间的平均间隔时间为9年。康复方案规定在4个月时恢复跑步，在4至9个月时恢复运动。视觉模拟评分法疼痛评分平均降低30分。国际膝关节文献委员会主观评分、Tegner-Lysholm评分和Tegner活动评分也有所改善。58%（35/60）的患者术后出现骨关节炎体征。1例患者（1.3%）因关节僵硬接受了关节镜下粘连松解术。未报告移植物再次断裂的发生率。
本系统评价发现，使用HTO进行ACLR翻修术可产生良好的术后功能预后、低并发症发生率，且未报告再次断裂情况。HTO与ACLR联合翻修术的主要适应证为后倾超过12°或严重内翻畸形。需要开展大样本量和长期随访的未来研究来证实这些结果。
