Asklepios Clinic St Georg, Hamburg, Germany.
University of Witten / Herdecke, Cologne Merheim Medical Center, Cologne, Germany.
Am J Sports Med. 2020 Dec;48(14):3478-3485. doi: 10.1177/0363546520966327. Epub 2020 Nov 2.
Both an elevated posterior tibial slope (PTS) and high-grade anterior knee laxity are often present in patients who undergo revision anterior cruciate ligament (ACL) surgery, and these conditions are independent risk factors for ACL graft failure. Clinical data on slope-correction osteotomy combined with lateral extra-articular tenodesis (LET) do not yet exist.
To evaluate the outcomes of patients undergoing revision ACL reconstruction (ACLR) and slope-correction osteotomy combined with LET.
Case series; Level of evidence, 4.
Between 2016 and 2018, we performed a 2-stage procedure: slope-correction osteotomy was performed first, and then revision ACLR in combination with LET was performed in 22 patients with ACLR failure and high-grade anterior knee laxity. Twenty patients (6 women and 14 men; mean age, 27.8 ± 8.6 years; range, 18-49 years) were evaluated, with a mean follow-up of 30.5 ± 9.3 months (range, 24-56 months), in this retrospective case series. Postoperative failure was defined as a side-to-side difference of ≥5 mm in the Rolimeter test and a pivot-shift grade of 2 or 3.
The PTS decreased from 15.3° to 8.9°, the side-to-side difference decreased from 7.2 to 1.1 mm, and the pivot shift was no longer evident in any of the patients. No patients exhibited revision ACLR failure and all patients showed good to excellent postoperative functional scores (mean ± SD: visual analog scale, 0.5 ± 0.6; Tegner, 6.1 ± 0.9; Lysholm, 90.9 ± 6.4; Knee injury and Osteoarthritis Outcome Score [KOOS] Symptoms, 95.2 ± 8.4; KOOS Pain, 94.7 ± 5.2; KOOS Activities of Daily Living, 98.5 ± 3.2; KOOS Function in Sport and Recreation, 86.8 ± 12.4; and KOOS Quality of Life, 65.4 ± 14.9).
Slope-correction osteotomy in combination with LET is a safe and reliable procedure in patients with high-grade anterior knee laxity and a PTS of ≥12°. Normal knee joint stability was restored and good to excellent functional scores were achieved after a follow-up of at least 2 years.
在接受前交叉韧带（ACL）翻修手术的患者中，通常存在胫骨后倾角（PTS）升高和高度膝关节前向松弛，这些情况是 ACL 移植物失败的独立危险因素。目前尚无关于坡度校正截骨术联合外侧关节外腱固定术（LET）的临床数据。
评估接受 ACL 翻修重建（ACLR）和坡度校正截骨术联合 LET 的患者的治疗效果。
病例系列研究；证据水平，4 级。
2016 年至 2018 年，我们进行了 2 期手术：首先进行坡度校正截骨术，然后对 22 例 ACLR 失败且高度膝关节前向松弛的患者进行 ACLR 联合 LET。在此回顾性病例系列研究中，对 20 例患者（6 名女性和 14 名男性；平均年龄 27.8±8.6 岁；范围，18-49 岁）进行了评估，平均随访 30.5±9.3 个月（范围，24-56 个月）。术后失败的定义为 Rolimeter 试验的侧间差值≥5mm 和髌股关节滑动试验 2 或 3 级。
PTS 从 15.3°降至 8.9°，侧间差值从 7.2mm 降至 1.1mm，所有患者的髌股关节滑动试验均不再明显。没有患者出现 ACLR 翻修失败，所有患者术后功能评分均良好至优秀（平均±标准差：视觉模拟评分，0.5±0.6；Tegner 评分，6.1±0.9；Lysholm 评分，90.9±6.4；膝关节损伤和骨关节炎结果评分[KOOS]症状，95.2±8.4；KOOS 疼痛，94.7±5.2；KOOS 日常活动，98.5±3.2；KOOS 运动和娱乐功能，86.8±12.4；KOOS 生活质量，65.4±14.9）。
对于高度膝关节前向松弛和 PTS≥12°的患者，胫骨后倾角校正截骨术联合 LET 是一种安全可靠的手术方法。至少随访 2 年后，恢复了正常的膝关节稳定性，获得了良好至优秀的功能评分。
