Byrne Kevin J, Hughes Jonathan D, Gibbs Christopher, Vaswani Ravi, Meredith Sean J, Popchak Adam, Lesniak Bryson P, Karlsson Jón, Irrgang James J, Musahl Volker
UPMC Freddie Fu Sports Medicine Center Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, USA.
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Knee Surg Sports Traumatol Arthrosc. 2022 Apr;30(4):1388-1395. doi: 10.1007/s00167-021-06607-7. Epub 2021 May 13.
Anterior cruciate ligament (ACL) graft failure is a complication that may require revision ACL reconstruction (ACL-R). Non-anatomic placement of the femoral tunnel is thought to be a frequent cause of graft failure; however, there is a lack of evidence to support this belief. The purpose of this study was to determine if non-anatomic femoral tunnel placement is associated with increased risk of revision ACL-R.
After screening all 315 consecutive patients who underwent primary single-bundle ACL-R by a single senior orthopedic surgeon between January 2012 and January 2017, 58 patients were found to have both strict lateral radiographs and a minimum of 24 months follow-up without revision. From a group of 456 consecutive revision ACL-R, patients were screened for strictly lateral radiographs and 59 patients were included in the revision group. Femoral tunnel placement for each patient was determined using a strict lateral radiograph taken after the primary ACL-R using the quadrant method. The center of the femoral tunnel was measured in both the posterior-anterior (PA) and proximal-distal (PD) dimensions and represented as a percentage of the total distance (normal center of anatomic footprint: PA 25% and PD 29%).
In the PA dimension, the revision group had significantly more anterior femoral tunnel placement compared with the primary group (38% ± 11% vs. 28% ± 6%, p < 0.01). Among patients who underwent revision; those with non-traumatic chronic failure had statistically significant more anterior femoral tunnel placement than those who experienced traumatic failure (41% ± 13% vs. 35% ± 8%, p < 0.03). In the PD dimension, the revision group had significantly more proximal femoral tunnel placement compared with the primary group (30% ± 9% vs 38% ± 9%, p < 0.01).
In this retrospective study of 58 patients with successful primary ACL-R compared with 59 patients with failed ACL-R, anterior and proximal (high) femoral tunnels for ACL-R were shown to be independent risk factors for ACL revision surgery. As revision ACL-R is associated with patient- and economic burden, particular attention should be given to achieving an individualized, anatomic primary ACL-R. Surgeons may reduce the risk of revision ACL-R by placing the center of the femoral tunnel within the anatomic ACL footprint.
Level III.
前交叉韧带（ACL）移植失败是一种可能需要进行ACL翻修重建（ACL-R）的并发症。股骨隧道的非解剖学位置被认为是移植失败的常见原因；然而，缺乏证据支持这一观点。本研究的目的是确定非解剖学股骨隧道位置是否与ACL-R翻修风险增加相关。
在筛选了2012年1月至2017年1月期间由一位资深骨科医生连续进行的315例初次单束ACL-R手术的患者后，发现58例患者有严格的侧位X线片且至少随访24个月未进行翻修。在一组456例连续的ACL-R翻修患者中，筛选出有严格侧位X线片的患者，59例患者被纳入翻修组。使用象限法，根据初次ACL-R术后拍摄的严格侧位X线片确定每位患者的股骨隧道位置。测量股骨隧道中心在前后（PA）和近端-远端（PD）维度上的位置，并表示为总距离的百分比（解剖足迹的正常中心：PA 25%，PD 29%）。
在PA维度上，翻修组的股骨隧道位置明显比初次手术组更靠前（38%±11%对28%±6%，p<0.01）。在接受翻修的患者中，非创伤性慢性失败患者的股骨隧道位置在统计学上比创伤性失败患者更靠前（41%±13%对35%±8%，p<0.03）。在PD维度上，翻修组的股骨隧道位置明显比初次手术组更靠近近端（30%±9%对38%±9%，p<0.01）。
在这项对58例初次ACL-R成功患者与59例ACL-R失败患者的回顾性研究中，ACL-R的股骨隧道靠前和靠近近端（高位）被证明是ACL翻修手术的独立危险因素。由于ACL-R翻修与患者负担和经济负担相关，应特别注意实现个体化的、解剖学的初次ACL-R。外科医生可通过将股骨隧道中心置于解剖学ACL足迹内来降低ACL-R翻修的风险。
III级。
