The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China.
Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.
Am J Sports Med. 2023 Sep;51(11):3053-3075. doi: 10.1177/03635465221119787. Epub 2022 Oct 3.
The rerupture or need for revision after anterior cruciate ligament reconstruction (ACLR) is a serious complication. Preventive strategies that target the early identification of risk factors are important to reduce the incidence of additional surgery.
To perform a systematic review and meta-analysis to investigate risk factors for revision or rerupture after ACLR.
Systematic review and meta-analysis; Level of evidence, 4.
Literature searches were performed in PubMed, Embase, and Web of Science from database inception to November 2021 and updated in January 2022. Quantitative, original studies reporting potential adjusted risk factors were included. Odds ratios (ORs) were calculated for potential risk factors.
A total of 71 studies across 13 countries with a total sample size of 629,120 met the inclusion criteria. Fifteen factors were associated with an increase in the risk of revision or rerupture after ACLR: male sex (OR, 1.27; 95% CI, 1.14-1.41), younger age (OR, 1.07; 95% CI, 1.05-1.08), lower body mass index (BMI) (OR, 1.03; 95% CI, 1.00-1.06), family history (OR, 2.47; 95% CI, 1.50-4.08), White race (OR, 1.32; 95% CI, 1.08-1.60), higher posterolateral tibial slope (OR, 1.15; 95% CI, 1.05-1.26), preoperative high-grade anterior knee laxity (OR, 2.30; 95% CI, 1.46-3.64), higher baseline Marx activity level (OR, 1.07; 95% CI, 1.02-1.13), return to a high activity level/sport (OR, 2.03; 95% CI, 1.15-3.57), an ACLR within less than a year after injury (OR, 2.05; 95% CI, 1.81-2.32), a concomitant medial collateral ligament (MCL) injury (OR, 1.62; 95% CI, 1.31-2.00), an anteromedial portal or transportal technique (OR, 1.36; 95% CI, 1.22-1.51), hamstring tendon (HT) autografts (vs bone-patellar tendon-bone [BPTB] autografts) (OR, 1.60; 95% CI, 1.40-1.82), allografts (OR, 2.63; 95% CI, 1.65-4.19), and smaller graft diameter (OR, 1.21; 95% CI, 1.05-1.38). The other factors failed to show an association with an increased risk of revision or rerupture after ACLR.
Male sex, younger age, lower BMI, family history, White race, higher posterolateral tibial slope, preoperative high-grade anterior knee laxity, higher baseline Marx activity level, return to a high activity level/sport, an ACLR within less than a year from injury, a concomitant MCL injury, an anteromedial portal or transportal technique, HT autografts (vs BPTB autografts), allografts, and smaller graft diameter may increase the risk of revision or rerupture after ACLR. Raising awareness and implementing effective preventions/interventions for risk factors are priorities for clinical practitioners to reduce the incidence of revision or rerupture after ACLR.
前交叉韧带重建（ACLR）后再次断裂或需要翻修是一种严重的并发症。针对风险因素的早期识别的预防策略对于降低再次手术的发生率非常重要。
进行系统评价和荟萃分析，以调查 ACLR 后翻修或再断裂的风险因素。
系统评价和荟萃分析；证据水平，4 级。
从数据库建立到 2021 年 11 月在 PubMed、Embase 和 Web of Science 进行文献检索，并于 2022 年 1 月进行更新。纳入了定量、原始研究报告潜在调整风险因素的研究。计算潜在风险因素的比值比（OR）。
共有来自 13 个国家的 71 项研究符合纳入标准，总样本量为 629120 人。15 个因素与 ACLR 后翻修或再断裂的风险增加相关：男性（OR，1.27；95%CI，1.14-1.41）、年龄较小（OR，1.07；95%CI，1.05-1.08）、较低的身体质量指数（BMI）（OR，1.03；95%CI，1.00-1.06）、家族史（OR，2.47；95%CI，1.50-4.08）、白种人（OR，1.32；95%CI，1.08-1.60）、较高的后外侧胫骨倾斜角（OR，1.15；95%CI，1.05-1.26）、术前高度的前膝松弛度（OR，2.30；95%CI，1.46-3.64）、较高的基线 Marx 活动水平（OR，1.07；95%CI，1.02-1.13）、恢复到高度活动水平/运动（OR，2.03；95%CI，1.15-3.57）、ACL 重建距受伤不到 1 年（OR，2.05；95%CI，1.81-2.32）、同时合并内侧副韧带（MCL）损伤（OR，1.62；95%CI，1.31-2.00）、前内侧入路或经皮入路技术（OR，1.36；95%CI，1.22-1.51）、腘绳肌腱（HT）自体移植物（vs 骨-髌腱-骨[BPTB]自体移植物）（OR，1.60；95%CI，1.40-1.82）、同种异体移植物（OR，2.63；95%CI，1.65-4.19）和较小的移植物直径（OR，1.21；95%CI，1.05-1.38）。其他因素与 ACLR 后翻修或再断裂的风险增加无关联。
男性、年龄较小、较低的 BMI、家族史、白种人、较高的后外侧胫骨倾斜角、术前高度的前膝松弛度、较高的基线 Marx 活动水平、恢复到高度活动水平/运动、ACL 重建距受伤不到 1 年、同时合并 MCL 损伤、前内侧入路或经皮入路技术、HT 自体移植物（vs BPTB 自体移植物）、同种异体移植物和较小的移植物直径可能会增加 ACLR 后翻修或再断裂的风险。提高对风险因素的认识并实施有效的预防/干预措施是临床医生的首要任务，以降低 ACLR 后翻修或再断裂的发生率。
