Sanborn Ryan M, Badger Gary J, Fleming Braden C, Kiapour Ata M, Fadale Paul D, Hulstyn Michael J, Owens Brett D, Proffen Benedikt, Sant Nicholas, Portilla Gabriela, Freiberger Christina, Henderson Rachael, Barnett Samuel, Costa Meggin, Chrostek Cynthia, Ecklund Kirsten, Micheli Lyle J, Murray Martha M, Yen Yi-Meng, Kramer Dennis E
Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Medical Biostatistics, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.
Am J Sports Med. 2023 Jan;51(1):49-57. doi: 10.1177/03635465221137873. Epub 2022 Nov 22.
Anterior cruciate ligament (ACL) revision surgery is challenging for both patients and surgeons. Understanding the risk factors for failure after bridge-enhanced ACL restoration (BEAR) may help with patient selection for ACL restoration versus ACL reconstruction.
To identify the preoperative risk factors for ACL revision surgery within the first 2 years after BEAR.
Case-control study; Level of evidence, 3.
Data from the prospective BEAR I, II, and III trials were used to determine the preoperative risk factors for ACL revision surgery. All patients with a complete ACL tear (aged 13-47 years, depending on the trial), who met all other inclusion/exclusion criteria and underwent a primary BEAR procedure within 30 to 50 days from the injury (dependent on the trial), were included. Demographic data (age, sex, body mass index), baseline patient-reported outcomes (International Knee Documentation Committee [IKDC] subjective score, Marx activity score), preoperative imaging results (ACL stump length, notch size, tibial slope), and intraoperative findings (knee hyperextension, meniscal status) were evaluated to determine their contribution to the risk of ipsilateral ACL revision surgery.
A total of 123 patients, with a median age of 17.6 years (interquartile range, 16-23 years), including 67 (54%) female patients, met study criteria. Overall, 18 (15%) patients required ACL revision surgery in the first 2 years after the BEAR procedure. On bivariate analyses, younger age ( = .011), having a contact injury at the time of the initial tear ( = .048), and increased medial tibial slope (MTS; = .029) were associated with a higher risk of ipsilateral revision surgery. Multivariable logistic regression analyses identified 2 independent predictors of revision: patient age and MTS. The odds of ipsilateral revision surgery were decreased by 32% for each 1-year increase in age (odds ratio, 0.684 [95% CI, 0.517-0.905]; = .008) and increased by 28% for each 1° increase in MTS (odds ratio, 1.280 [95% CI, 1.024-1.601]; = .030). Sex, baseline IKDC or Marx score, knee hyperextension, and meniscal status were not significant predictors of revision.
Younger age and higher MTS were predictors of ipsilateral ACL revision surgery after the BEAR procedure. Younger patients with higher tibial slopes should be aware of the increased risk for revision surgery when deciding to undergo ACL restoration.
前交叉韧带（ACL）翻修手术对患者和外科医生而言都具有挑战性。了解桥接增强ACL修复术（BEAR）后失败的风险因素可能有助于在ACL修复与ACL重建之间进行患者选择。
确定BEAR术后2年内ACL翻修手术的术前风险因素。
病例对照研究；证据等级，3级。
前瞻性BEAR I、II和III试验的数据用于确定ACL翻修手术的术前风险因素。纳入所有ACL完全撕裂（年龄13 - 47岁，取决于试验）、符合所有其他纳入/排除标准且在受伤后30至50天内（取决于试验）接受初次BEAR手术的患者。评估人口统计学数据（年龄、性别、体重指数）、患者报告的基线结局（国际膝关节文献委员会[IKDC]主观评分、马克思活动评分）、术前影像学结果（ACL残端长度、髁间切迹大小、胫骨坡度）和术中发现（膝关节过伸、半月板状态），以确定它们对同侧ACL翻修手术风险的影响。
共有123例患者符合研究标准，中位年龄为17.6岁（四分位间距，16 - 23岁），其中67例（54%）为女性患者。总体而言，18例（15%）患者在BEAR手术后的前2年需要进行ACL翻修手术。在双变量分析中，年龄较小（P = 0.011）、初次撕裂时发生接触性损伤（P = 0.048）以及内侧胫骨坡度（MTS）增加（P = 0.029）与同侧翻修手术的较高风险相关。多变量逻辑回归分析确定了翻修的2个独立预测因素：患者年龄和MTS。年龄每增加1岁，同侧翻修手术的几率降低32%（优势比，0.684[95%置信区间，0.517 - 0.905]；P = 0.008），MTS每增加1°，几率增加28%（优势比，1.280[95%置信区间，1.024 - 1.601]；P = 0.030）。性别、基线IKDC或马克思评分、膝关节过伸和半月板状态不是翻修的显著预测因素。
年龄较小和较高的MTS是BEAR术后同侧ACL翻修手术的预测因素。胫骨坡度较高的年轻患者在决定接受ACL修复时应意识到翻修手术风险增加。
