胫骨后倾对前交叉韧带重建术后使用自体腘绳肌腱的临床结果和生存率的影响：至少 10 年随访。
Influence of Posterior Tibial Slope on Clinical Outcomes and Survivorship After Anterior Cruciate Ligament Reconstruction Using Hamstring Autografts: A Minimum of 10-Year Follow-Up.
机构信息
Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Republic of Korea.
Department of Physical Education, Graduate School of Education, Yongin University, Yongin-si, Gyeongki-do, Republic of Korea.
出版信息
Arthroscopy. 2020 Oct;36(10):2718-2727. doi: 10.1016/j.arthro.2020.06.011. Epub 2020 Jun 15.
PURPOSE
To investigate the influence of medial and lateral posterior tibial slope (PTS) on long-term clinical outcomes and survivorship after anterior cruciate ligament (ACL) reconstruction using hamstring autografts.
METHODS
A total of 232 patients (mean age, 28.2 ± 8.9 years) who underwent primary ACL reconstruction from October 2002 to July 2007 were retrospectively reviewed. Patients with multiple ligament reconstruction, total meniscectomy, contralateral knee surgery before ACL reconstruction, open growth plate, and less than 10-year follow-up were excluded in the study. The medial and lateral PTS were measured from preoperative magnetic resonance imaging. Based on Li et al.'s previous study, the patients were divided into 2 groups according to their medial PTS (≤5.6° vs >5.6°) and lateral PTS (≤3.8° vs >3.8°), respectively. Clinical outcomes (clinical scores, stability tests and failure rate) were compared between the groups at the last follow-up. Furthermore, survival analysis was performed using the Kaplan-Meier method.
RESULTS
All clinical scores (International Knee Documentation Committee subjective, Lysholm, and Tegner activity scores) and stability tests (physical examinations and side-to-side difference in Telos stress radiographs) were insignificantly different between the 2 groups classified based on medial or lateral PTS. However, the failure rate was significantly higher in patients with medial PTS >5.6° (16.1% vs 5.1%, P = .01) or lateral PTS >3.8° (14.5% vs 4.7%; P = .01). The odds ratios of graft failure due to increased medial and lateral PTS were 3.18 (95% confidence interval, 1.22-8.28; P = .02) and 3.43 (95% confidence interval, 1.29-9.09; P = .01), respectively. In addition, the 10-year survivorship was significantly lower in patients with medial PTS >5.6° (83.9% vs 94.9%, P = .01) or lateral PTS >3.8° (85.5% vs 96.0%; P = .01).
CONCLUSIONS
Increased medial (>5.6°) and lateral (>3.8°) PTS were associated with higher failure rate and lower survivorship at a minimum of 10-year follow-up after primary ACL reconstruction using hamstring autografts.
LEVEL OF EVIDENCE
Level III, retrospective comparative trial.
目的
研究使用自体腘绳肌腱重建前交叉韧带（ACL）后，胫骨后内侧和后外侧倾斜（PTS）对长期临床结果和生存率的影响。
方法
回顾性分析 2002 年 10 月至 2007 年 7 月期间行初次 ACL 重建的 232 例患者（平均年龄 28.2±8.9 岁）。排除多韧带重建、全半月板切除术、ACL 重建前对侧膝关节手术、开放性生长板和随访时间少于 10 年的患者。从术前磁共振成像中测量胫骨后内侧和后外侧 PTS。根据 Li 等人的先前研究，根据患者的胫骨后内侧 PTS（≤5.6°与>5.6°）和后外侧 PTS（≤3.8°与>3.8°）将患者分为 2 组。在最后一次随访时比较两组之间的临床结果（临床评分、稳定性测试和失败率）。此外，使用 Kaplan-Meier 法进行生存分析。
结果
根据胫骨后内侧或后外侧 PTS 分组的两组之间，所有临床评分（国际膝关节文献委员会主观评分、Lysholm 评分和 Tegner 活动评分）和稳定性测试（体格检查和 Telos 压力侧位片的侧间差异）均无显著差异。然而，胫骨后内侧 PTS>5.6°（16.1%比 5.1%，P=0.01）或胫骨后外侧 PTS>3.8°（14.5%比 4.7%，P=0.01）的患者失败率明显更高。由于胫骨后内侧和后外侧 PTS 增加，导致移植物失败的优势比分别为 3.18（95%置信区间，1.22-8.28；P=0.02）和 3.43（95%置信区间，1.29-9.09；P=0.01）。此外，胫骨后内侧 PTS>5.6°（83.9%比 94.9%，P=0.01）或胫骨后外侧 PTS>3.8°（85.5%比 96.0%，P=0.01）的患者 10 年生存率明显更低。
结论
初次使用自体腘绳肌腱重建 ACL 后，胫骨后内侧（>5.6°）和后外侧（>3.8°）PTS 与较高的失败率和较低的生存率相关，随访时间至少为 10 年。
证据水平
III 级，回顾性比较试验。
Zotero 插件