Chen Kallie J, Lee Eric J, Kliethermes Stephanie A, Scerpella Tamara A
University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Orthop J Sports Med. 2023 Jun 30;11(6):23259671231180860. doi: 10.1177/23259671231180860. eCollection 2023 Jun.
Limited evidence suggests a positive correlation between tibial tubercle-trochlear groove (TT-TG) distance and the risk of native anterior cruciate ligament (ACL) tear. The relationship between TT-TG distance and the risk of ACL graft failure is unknown.
TT-TG distance is independently associated with risk of ACL graft failure.
Cohort study; Level of evidence, 3.
All patients who underwent ACL revision surgery between 2010 and 2018 at a single institution were identified. A control cohort underwent primary ACL reconstruction (ACLR) between 2006 and 2015, with no evidence of graft failure at 8.1 ± 2.5 years postoperatively. Record review included anthropometrics, graft type, and estimated Tegner activity score at ≥6 months after primary ACLR. Magnetic resonance imaging (MRI) scans after native ACL tear (controls) or graft failure (revision cohort) were assessed for (1) TT-TG distance, (2) proximal tibial slopes, (3) depth of tibial plateau concavity, and (4) tunnel position (revision cohort). Associations between ACL graft failure and MRI measurements, surgical variables, and patient characteristics were evaluated with logistic regression analyses. Sensitivity analyses, excluding patients with tunnel malposition, were performed to confirm multivariable results in patients with "ideal" tunnel placement.
Participants included 153 patients who underwent revisions and 144 controls. Controls were older than the patients who underwent revision (26.6 ± 8.8 vs 20.6 ± 7.3 years; < .001). The mean TT-TG distance and lateral posterior tibial slope (PTS) were smaller for the control group than for the revision group (TT-TG: 9.3 ± 3.9 vs 11.2 ± 4.2 mm; < .001; lateral PTS: 6.2° ± 3.3° vs 7.2° ± 3.6°; = .01). TT-TG distance, lateral PTS, and age were associated with risk of ACL graft failure by multivariable analysis (OR, 1.15; 95% CI, 1.07-1.23; < .001; OR, 1.13; 95% CI, 1.04-1.22; = .004; and OR, 0.90; 95% CI, 0.87-0.94; < .001, respectively). With sensitivity analyses, TT-TG distance, lateral PTS, and age at index surgery remained significantly and independently associated with ACL graft failure.
Increased TT-TG distance, increased lateral PTS, and younger age are independently associated with increased odds of ACL graft failure. Patients with these characteristics may require a more comprehensive strategy to reduce the risk of ACL reinjury.
有限的证据表明胫骨结节 - 滑车沟（TT - TG）距离与原发性前交叉韧带（ACL）撕裂风险之间存在正相关。TT - TG距离与ACL移植物失败风险之间的关系尚不清楚。
TT - TG距离与ACL移植物失败风险独立相关。
队列研究；证据等级，3级。
确定了2010年至2018年在单一机构接受ACL翻修手术的所有患者。一个对照组在2006年至2015年期间接受了初次ACL重建（ACLR），术后8.1±2.5年无移植物失败的证据。记录回顾包括人体测量学、移植物类型以及初次ACLR后≥6个月时的估计Tegner活动评分。对原发性ACL撕裂（对照组）或移植物失败（翻修队列）后的磁共振成像（MRI）扫描进行评估，以确定（1）TT - TG距离，（2）胫骨近端坡度，（3）胫骨平台凹陷深度，以及（4）隧道位置（翻修队列）。通过逻辑回归分析评估ACL移植物失败与MRI测量值、手术变量和患者特征之间的关联。进行敏感性分析，排除隧道位置不当的患者，以确认“理想”隧道放置患者的多变量结果。
参与者包括153例接受翻修手术的患者和144例对照组。对照组比接受翻修手术的患者年龄更大（26.6±8.8岁对20.6±7.3岁；P <.001）。对照组的平均TT - TG距离和胫骨后外侧坡度（PTS）小于翻修组（TT - TG：9.3±3.9对11.2±4.2mm；P <.001；外侧PTS：6.2°±3.3°对7.2°±3.6°；P =.01）。通过多变量分析，TT - TG距离、外侧PTS和年龄与ACL移植物失败风险相关（OR，1.15；95%CI，1.07 - 1.23；P <.001；OR，1.13；95%CI，1.04 - 1.22；P =.004；以及OR，0.90；95%CI，0.87 - 0.94；P <.001，分别）。通过敏感性分析，初次手术时的TT - TG距离、外侧PTS和年龄仍然与ACL移植物失败显著且独立相关。
TT - TG距离增加、外侧PTS增加和年龄较小与ACL移植物失败几率增加独立相关。具有这些特征的患者可能需要更全面的策略来降低ACL再次损伤的风险。
