Department of Osteoarthritis and Sport Surgery, Grenoble-Alpes CHU, South Teaching Hospital, Kimberley Avenue, BP 338, 38434, Échirolles Cedex, France.
Chirurgie du Sport, Clinique du Sport Paris V, Ramsay-Générale de Santé, 75005, Paris, France.
Eur J Orthop Surg Traumatol. 2023 Jul;33(5):2091-2099. doi: 10.1007/s00590-022-03406-9. Epub 2022 Oct 6.
This case-control study aimed to assess the influence of BMI and PTS on subsequent ACL injury affecting either ACL graft or the native ACL of the contralateral knee after primary ACL reconstruction.
A retrospective case-control study was performed using a cohort of patients who underwent arthroscopic ACL reconstruction between 2010 and 2020 using the same surgical procedure: Hamstring tendon autograft. The study group (group I) included all the patients (n = 94) during this period who sustained a subsequent ACL injury. The control group (group II) consisted of 94 patients randomly selected (matched Group I in terms of sex, age, and ACL graft) who did not sustain any further ACL injury. PTS was measured by two blinded surgeons on lateral knee view radiographs of the operated knee after primary ACL. BMI in kg/m was measured during the preoperative anesthesia consultation. Exclusion criteria were: non-true or rotated lateral knee radiographs of the operated knee post-ACLR, associated knee ligament injury requiring surgical management, iterative knee surgeries, open growth plate, and related fracture.
The mean posterior tibial slope in group I was 7.5° ± 2.9, and 7.2° ± 2.0 in group II. A PTS angle cutoff was set at 10 degrees. The rate of patients showing a PTS ≥ 10° was significantly higher in group I compared to group II (p < 0.01). Patients with PTS ≥ 10° were 5.7 times more likely to sustain a subsequent ACL injury, (OR: 5.7 95% CI[1.858-17.486]). The Average BMI in group I was 24.5 ± 3.7 kg.m compared to group II which was 23.3 ± 3.0 kg.m. There were no significant differences in any of the four BMI categories between both groups (p value 0.289). A series of BMI cut-offs were also analyzed at 23 to30 kg/m, and there was no significant difference between both groups.
A posterior tibial slope equal to or above 10 degrees measured on lateral knee radiographs was associated with 5.7 times higher risk of ACL graft rupture or contralateral native ACL injury; however, BMI was not.
本病例对照研究旨在评估 BMI 和 PTS 对初次 ACL 重建后同侧 ACL 移植物或对侧膝关节 ACL 原发性损伤后继发 ACL 损伤的影响。
回顾性病例对照研究，纳入 2010 年至 2020 年期间接受同种手术（腘绳肌腱自体移植物）关节镜下 ACL 重建的患者队列。研究组（I 组）包括在此期间发生后续 ACL 损伤的所有患者（n=94）。对照组（II 组）由 94 名随机选择的患者组成（在性别、年龄和 ACL 移植物方面与 I 组匹配），他们没有发生任何进一步的 ACL 损伤。术后 ACL 后，两名盲法外科医生通过外侧膝关节 X 线片测量 PTS。BMI（kg/m）在术前麻醉咨询期间测量。排除标准为：术后 ACL 外侧膝关节 X 线片不真实或旋转、需要手术治疗的相关膝关节韧带损伤、迭代膝关节手术、开放生长板和相关骨折。
I 组的平均胫骨后倾角为 7.5°±2.9，II 组为 7.2°±2.0。设定 PTS 角度截断值为 10 度。与 II 组相比，I 组 PTS≥10°的患者比例明显更高（p<0.01）。PTS≥10°的患者发生后续 ACL 损伤的可能性是 II 组的 5.7 倍（OR：5.7，95%CI[1.858-17.486]）。I 组的平均 BMI 为 24.5±3.7kg.m，而 II 组为 23.3±3.0kg.m。两组之间的任何四个 BMI 类别均无显着差异（p 值 0.289）。还分析了一系列 23 至 30kg/m 的 BMI 截止值，两组之间没有显着差异。
外侧膝关节 X 线片上测量的胫骨后倾角等于或大于 10°与 ACL 移植物破裂或对侧 ACL 原发性损伤的风险增加 5.7 倍相关；然而，BMI 不是。
