Duerr Robert, Ormseth Benjamin, Adelstein Jeremy, Garrone Andrew, DiBartola Alex, Kaeding Christopher, Flanigan David, Siston Robert, Magnussen Robert
Jameson Crane Sports Medicine Institute, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A..
Jameson Crane Sports Medicine Institute, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.
Arthroscopy. 2023 May;39(5):1299-1309.e6. doi: 10.1016/j.arthro.2022.12.034. Epub 2023 Jan 21.
To evaluate the association of posterior tibial slope (PTS) with anterior cruciate ligament (ACL) reinjury following primary ACL reconstruction.
PubMed, Scopus, Embase, and CINAHL databases were searched from inception through March 1, 2021, to retrieve relevant studies. Comparative studies reporting PTS measurements in a cohort of patients experiencing ACL graft failure versus patients with intact primary ACL reconstruction or studies comparing patients undergoing revision ACL reconstruction versus primary ACL reconstruction were included for analysis. A random-effects model was used to calculate the overall standardized mean difference (SMD) between groups. The following inclusion criteria were used: English language; full text available; Level I, II, or III evidence; studies in humans; and skeletally mature patients.
After we systematically screened 1,912 studies, 15 studies met the inclusion/exclusion criteria. Radiographic measurements were used in 6 studies reporting medial PTS in 411 ACL failures versus 2808 controls. Patients with ACL failure had significantly greater medial PTS compared with controls (SMD 0.50; 95% confidence interval [CI] 0.23-0.77; P < .001). Magnetic resonance imaging (MRI) was used in 9 studies reporting lateral PTS measurements in 641 patients with a failed ACL reconstruction compared with 705 controls. Seven of the MRI studies also measured medial PTS in 552 failures versus 641 controls. Patients with ACL failure had significantly greater lateral PTS on MRI (SMD 0.58; 95% CI 0.13-1.03; P = .012) and medial PTS on MRI (SMD 0.59; 95% CI 0.23-0.96; P = .001) compared with controls.
The present meta-analysis demonstrated that patients with elevated PTS on radiographs and MRI are at increased risk for ACL graft failure after primary ACL reconstruction.
Level III, meta-analysis of Level III studies.
评估初次前交叉韧带（ACL）重建术后胫骨后倾坡度（PTS）与ACL再损伤之间的关联。
检索PubMed、Scopus、Embase和CINAHL数据库自建库至2021年3月1日的相关研究。纳入报告ACL移植物失败患者队列与初次ACL重建完整患者的PTS测量值的比较研究，或比较接受ACL翻修重建患者与初次ACL重建患者的研究进行分析。采用随机效应模型计算组间总体标准化均值差（SMD）。使用以下纳入标准：英文文献；有全文；I、II或III级证据；人体研究；骨骼成熟患者。
在系统筛选1912项研究后，15项研究符合纳入/排除标准。6项研究采用影像学测量，报告了411例ACL失败患者与2808例对照者的内侧PTS。ACL失败患者的内侧PTS显著高于对照组（SMD 0.50；95%置信区间[CI] 0.23 - 0.77；P <.001）。9项研究采用磁共振成像（MRI），报告了641例ACL重建失败患者与705例对照者的外侧PTS测量值。其中7项MRI研究还测量了552例失败患者与641例对照者的内侧PTS。与对照组相比，ACL失败患者的MRI外侧PTS（SMD 0.58；95% CI 0.13 - 1.03；P =.012）和MRI内侧PTS（SMD 0.59；95% CI 0.23 - 0.96；P =.001）显著更高。
本荟萃分析表明，X线片和MRI显示PTS升高的患者在初次ACL重建后发生ACL移植物失败的风险增加。
III级，III级研究的荟萃分析。
