Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy.
Knee Surg Sports Traumatol Arthrosc. 2021 Jun;29(6):1690-1700. doi: 10.1007/s00167-020-06195-y. Epub 2020 Jul 31.
To assess the role of Tibial Plateau Slope (TPS) as risk factor for early Anterior Cruciate Ligament (ACL) reconstruction failure and contralateral ACL injury in a population of patients with less than 18 years of age and operated on with the same surgical technique.
Ninety-four consecutive patients (mean age 15.7 ± 1.5 years) with at least 2 years of follow-up, who underwent ACL reconstruction with a single-bundle plus lateral-plasty hamstring technique in the same centre were included. Subsequent ACL injuries (ipsilateral ACL revision or contralateral ACL reconstruction) were assessed within the first 2 years after surgery. Anterior, central, posterior TPS of medial compartment were measured on lateral radiographs and compared between patients with intact graft and those with a second injury. Cut-off values with sensitivity and specificity were calculated with receiver operating characteristic (ROC) analysis. Survival analysis for second ACL injuries and multivariate analysis were performed.
Eight patients (9%) had ipsilateral ACL Revision and eight patients (9%) had contralateral ACL reconstruction. Patients with contralateral injury had a higher Central TPS with respect to those without second injury (12.6° ± 2.8° vs 9.3° ± 3.7°, p = 0.042). No differences were present in patients with ipsilateral ACL revision. Sensitivity and specificity for central TPS slope ≥ 12° to detect a contralateral rupture were 63% and 75% (p = 0.0092), for Anterior TPS were 100% and 52% (p = 0.0009). Patients with TPS values exceeding these cut-offs had higher rate of contralateral ACL injuries (19%vs4%, p = 0.0420) and lower 2-year survival (p = 0.0049). Multivariate analysis identified pre-operative sport level and TPS (either anterior or central) as risk factors for contralateral injuries.
Steep tibial plateau slope ≥ 12° is associated with a higher risk of contralateral ACL injury within 2 years after ACL reconstruction in patients less than 18 years of age. However, TPS has no role in early ipsilateral re-injury after combined ACL reconstruction and lateral plasty. The clinical relevance is that both the surgeon and the patient should be aware of this higher risk and consider it in the rehabilitation phase to reduce the incidence of such injuries.
III.
评估胫骨平台斜率（TPS）作为危险因素的作用，对于年龄小于 18 岁的患者，采用相同的手术技术，进行前交叉韧带（ACL）重建后，早期 ACL 重建失败和对侧 ACL 损伤。
共纳入 94 例连续患者（平均年龄 15.7 ± 1.5 岁），至少随访 2 年，在同一中心采用单束加外侧髌腱重建 ACL。在术后 2 年内评估同侧 ACL 再损伤（同侧 ACL 翻修或对侧 ACL 重建）。在侧位片上测量内侧间室的前、中、后 TPS，并比较移植物完整和有二次损伤的患者之间的 TPS。采用接收者操作特征（ROC）分析计算具有敏感性和特异性的截断值。对二次 ACL 损伤进行生存分析和多变量分析。
8 例（9%）患者出现同侧 ACL 翻修，8 例（9%）患者对侧 ACL 重建。与无二次损伤的患者相比，对侧损伤患者的中央 TPS 更高（12.6°±2.8°比 9.3°±3.7°，p=0.042）。同侧 ACL 翻修的患者没有差异。中央 TPS 斜率≥12°以检测对侧破裂的敏感性和特异性分别为 63%和 75%（p=0.0092），前 TPS 分别为 100%和 52%（p=0.0009）。TPS 值超过这些截断值的患者对侧 ACL 损伤发生率更高（19%比 4%，p=0.0420），2 年生存率更低（p=0.0049）。多变量分析确定术前运动水平和 TPS（前或中央）是对侧损伤的危险因素。
胫骨平台斜率≥12°与年龄小于 18 岁的 ACL 重建后 2 年内对侧 ACL 损伤的风险增加相关。然而，TPS 在联合 ACL 重建和外侧成形术后同侧早期再损伤中没有作用。临床意义在于，外科医生和患者都应该意识到这种更高的风险，并在康复阶段考虑降低这种损伤的发生率。
III。
