Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China.
Am J Sports Med. 2020 Dec;48(14):3486-3494. doi: 10.1177/0363546520963083. Epub 2020 Oct 28.
Steep posterior tibial slope (PTS; >13°), excessive anterior tibial subluxation (ATS) in extension (>10 mm), and meniscus posterior horn tears (MPHTs) have been identified to be associated with primary anterior cruciate ligament (ACL) reconstruction (ACLR) failure. Recent studies have reported that steep PTS is directly correlated with excessive ATS in extension and concomitant MPHTs, especially for those patients with chronic (>6 months) ACL deficiency. There is increasing biomechanical evidence that slope-reducing tibial osteotomy decreases ATS in extension and protects the ACL graft.
Slope-reducing tibial osteotomy combined with primary ACLR is effective for producing improved knee stability in patients with steep PTS (>13°), excessive ATS in extension (>10 mm), and concomitant chronic MPHTs (>6 months).
Case series; Level of evidence, 4.
Between June 2016 and January 2018, 18 patients with ACL injuries who had steep PTS (>13°), excessive ATS in extension (>10 mm), and concomitant chronic MPHTs (>6 months) underwent slope-reducing tibial osteotomy combined with primary ACLR. The PTS and anterior subluxation of the lateral and medial compartment (ASLC and ASMC) in extension before and after the index procedures were regarded as primary clinical outcomes. Moreover, Lysholm score, Tegner activity score, International Knee Documentation Committee (IKDC) objective grade, pivot-shift test, and KT-1000 side-to-side difference were evaluated preoperatively and at the minimum 2-year follow-up visit.
The mean PTS was 18.5° (range, 17°-20°) preoperatively and 8.1° (range, 7°-9°) postoperatively ( < .01). The mean ASLC and ASMC in extension were 12.1 mm and 11.9 mm preoperatively, which reduced to 1.0 mm and 1.5 mm at the last follow-up visit ( < .05). In addition, all of the following showed significant improvements (pre- vs postoperatively): mean Lysholm score (46.5 vs 89.5; < .05), mean Tegner activity score (5.7 vs 7.3; < .05), IKDC objective grading results (18 grade D vs 14 grade A and 4 grade B; < .05), pivot-shift tests (15 grade 2+ and 3 grade 3+ vs 18 grade 0; < .01), and KT-1000 side-to-side difference (13.0 mm vs 1.6 mm; < .01). Moreover, no graft reruptures were found at the final follow-up visit.
In this study, slope-reducing tibial osteotomy combined with primary ACLR effectively improved knee stability in patients with steep PTS (>13°), excessive ATS in extension (>10 mm), and concomitant chronic MPHTs (>6 months).
陡峭的胫骨后倾角（PTS；>13°）、伸展位胫骨前侧过度半脱位（ATS；>10mm）和后角半月板撕裂（MPHTs）与原发性前交叉韧带（ACL）重建（ACLR）失败有关。最近的研究报告称，陡峭的 PTS 与伸展位的过度 ATS 和并发的 MPHTs 直接相关，尤其是对于那些患有慢性（>6 个月）ACL 缺失的患者。越来越多的生物力学证据表明，降低坡度的胫骨截骨术可减少伸展位的 ATS，并保护 ACL 移植物。
降低坡度的胫骨截骨术联合原发性 ACLR 可有效改善 PTS（>13°）、伸展位 ATS（>10mm）和并发慢性 MPHTs（>6 个月）患者的膝关节稳定性。
病例系列；证据水平，4 级。
2016 年 6 月至 2018 年 1 月，18 例 PTS（>13°）、伸展位 ATS 过度（>10mm）和并发慢性 MPHTs（>6 个月）的 ACL 损伤患者接受了降低坡度的胫骨截骨术联合原发性 ACLR。指数手术后，胫骨后倾角和外侧及内侧间室的前侧半脱位（ASLC 和 ASMC）的 PTS 和伸展位前侧半脱位被视为主要临床结果。此外，术前和至少 2 年随访时评估 Lysholm 评分、Tegner 活动评分、国际膝关节文献委员会（IKDC）客观分级、膝关节旋转轴试验和 KT-1000 侧间差值。
术前 PTS 平均为 18.5°（范围，17°-20°），术后为 8.1°（范围，7°-9°）（<0.01）。术前 ASLC 和 ASMC 在伸展位的平均宽度分别为 12.1mm 和 11.9mm，最后随访时分别减少至 1.0mm 和 1.5mm（<0.05）。此外，以下所有指标均有显著改善（术前与术后）：Lysholm 评分（46.5 分与 89.5 分；<0.05）、Tegner 活动评分（5.7 分与 7.3 分；<0.05）、IKDC 客观分级结果（18 级 D 与 14 级 A 和 4 级 B；<0.05）、膝关节旋转轴试验（15 级 2+和 3 级 3+与 18 级 0；<0.01）和 KT-1000 侧间差值（13.0mm 与 1.6mm；<0.01）。此外，末次随访时无移植物再断裂。
在这项研究中，降低坡度的胫骨截骨术联合原发性 ACLR 可有效改善 PTS（>13°）、伸展位 ATS（>10mm）和并发慢性 MPHTs（>6 个月）患者的膝关节稳定性。
