Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP, Brazil; Hospital Sírio Libanês, São Paulo - SP, Brazil.
Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP, Brazil.
Arthroscopy. 2024 Mar;40(3):898-907. doi: 10.1016/j.arthro.2023.07.057. Epub 2023 Aug 12.
To create a cut-off point for hyperextension that best discriminates retear and to verify whether this cut-off point can predict retear regardless of other characteristics after primary anterior cruciate ligament (ACL) reconstruction with hamstrings autograft.
A cohort of patients submitted to primary isolated ACL reconstruction with hamstrings autografts was retrospectively evaluated. Patients were stratified according to the degree of passive knee hyperextension measured in the normal contralateral knee. The following data were collected: patient age and sex, time from injury to surgery, knee hyperextension, KT-1000 and pivot-shift, associated meniscus injury, intra-articular graft size, follow-up time, graft failure, and postoperative Lysholm and subjective International Knee Documentation Committee scores.
Data from 457 patients were evaluated. Median age was 31 years. Thirty-two (7.0%) presented with retear. There was a significant difference in hyperextension between patients with and without retear (P < .001), with the cut-off point established by the receiver operating characteristic curve from 6.5°. Patients with greater hyperextension had a statistically greater frequency of women, longer injury time, greater intra-articular graft diameter, greater postoperative KT-1000, and greater frequency of retear, whereas the subjective International Knee Documentation Committee and Lysholm scores were statistically lower in patients with greater hyperextension. Only hyperextension showed a statistically significant association with re-rupture (P < .001). The odds of retear in patients with hyperextension greater than 6.5 was 14.65 times the odds of patients with hyperextension less than 6.5.
Patients with more than 6.5° of hyperextension are 14.6 times more likely to have a graft rupture than patients with lower hyperextension when submitted to ACL reconstruction with hamstring tendons. Also, they present worse knee stability by the KT-1000 test and worse functional outcomes. Therefore, patients with this degree of hyperextension should not have isolated reconstruction with hamstrings as their first choice.
Level III, retrospective comparative prognostic trial.
建立一个区分再撕裂的过伸截断点，并验证该截断点是否可以在原发前交叉韧带（ACL）重建后，无论其他特征如何，预测再撕裂。
回顾性评估了一组接受腘绳肌腱原发 ACL 重建的患者。根据对健侧膝关节被动过伸程度的测量，将患者分层。收集以下数据：患者年龄和性别、受伤至手术时间、膝关节过伸、KT-1000 和髌骨轴移试验、合并半月板损伤、关节内移植物大小、随访时间、移植物失败以及术后 Lysholm 和主观国际膝关节文献委员会评分。
共评估了 457 名患者的数据。中位年龄为 31 岁。32 例（7.0%）出现再撕裂。有再撕裂和无再撕裂患者的过伸程度存在显著差异（P<0.001），ROC 曲线确定的截断点为 6.5°。过伸程度较大的患者中，女性比例、受伤时间较长、关节内移植物直径较大、术后 KT-1000 较大以及再撕裂的发生率较高，而过伸程度较大的患者的主观国际膝关节文献委员会和 Lysholm 评分较低。只有过伸程度与再破裂有统计学显著关联（P<0.001）。过伸程度大于 6.5°的患者发生再撕裂的几率是过伸程度小于 6.5°的患者的 14.65 倍。
在接受腘绳肌腱 ACL 重建的患者中，过伸程度大于 6.5°的患者发生移植物破裂的几率是过伸程度小于 6.5°的患者的 14.6 倍。此外，他们的 KT-1000 测试膝关节稳定性较差，功能结果也较差。因此，有这种程度过伸的患者不应首选腘绳肌腱进行孤立重建。
III 级，回顾性比较预后试验。
