Department of Orthopaedic Surgery, University of Rome "La Sapienza", Sant'Andrea Hospital, Via di Grottarossa, 1035, 00189, Rome, Italy.
U-Conn, Storrs, CT, 06269, USA.
Int Orthop. 2021 Jun;45(6):1469-1475. doi: 10.1007/s00264-020-04865-7. Epub 2020 Nov 4.
The purpose of this study was to determine the most reliable radiographic measurement method to evaluate PTS as a risk factor for ACL reconstruction failure.
Patients who underwent ACL reconstruction or ACL revision reconstruction between January 2009 and December 2014 by a single surgeon were included. Fifty-two consecutive patients who underwent ACL revision reconstruction were compared to a random selection of 52 patients who underwent primary ACL reconstruction and a control group of 52 patients without ACL injury. ACL reconstruction was performed using either ipsilateral (primary) or contralateral (revision) quadrupled hamstring autograft. Lateral knee radiographs were evaluated using three methods: (1) longitudinal axis, (2) anterior tibial cortex axis, and (3) posterior tibial cortex.
A significant difference was found between subjects who underwent ACL reconstruction and control knees (6.79° vs. 5.31°, p = 0.046) using the posterior tibial cortex method. No other statistical significance was found between groups. A multiple linear regression analysis found that the PTS as measured by any method was not affected by the patient's age, sex, height, weight, and BMI. All methods of measurement for PTS demonstrated excellent (ICC > 0.90) intra-rater and inter-rater reliability, but only the posterior tibial cortex method maintained excellent intra-rater and inter-rater reliability (ICC > 0.90) when evaluating patients with ACL revision reconstruction.
The posterior tibial cortex measurement is the most reliable method for analyzing the PTS on lateral knee radiographs in patients undergoing ACL revision reconstruction.
本研究旨在确定最可靠的影像学测量方法，以评估 PTS 作为 ACL 重建失败的风险因素。
纳入 2009 年 1 月至 2014 年 12 月间由同一位外科医生进行 ACL 重建或 ACL 翻修重建的患者。将 52 例连续接受 ACL 翻修重建的患者与随机选择的 52 例接受初次 ACL 重建的患者和 52 例无 ACL 损伤的对照组进行比较。ACL 重建采用同侧（初次）或对侧（翻修）四股腘绳肌腱自体移植物。使用三种方法评估外侧膝关节 X 线片：（1）长轴，（2）胫骨前皮质轴，（3）胫骨后皮质。
使用胫骨后皮质法，接受 ACL 重建的患者与对照组膝关节之间存在显著差异（6.79° vs. 5.31°，p = 0.046）。组间无其他统计学差异。多元线性回归分析发现，无论采用哪种方法测量 PTS，均不受患者年龄、性别、身高、体重和 BMI 的影响。所有 PTS 测量方法的组内和组间可信度均很高（ICC > 0.90），但只有胫骨后皮质法在评估 ACL 翻修重建患者时具有很高的组内和组间可信度（ICC > 0.90）。
胫骨后皮质测量法是分析接受 ACL 翻修重建患者外侧膝关节 X 线片 PTS 的最可靠方法。
