University of Virginia Health System, Department of Orthopaedic Surgery, USA.
University of Virginia Health System, Department of Orthopaedic Surgery, USA.
J ISAKOS. 2024 Aug;9(4):709-716. doi: 10.1016/j.jisako.2024.06.010. Epub 2024 Jun 28.
Patients with excessive posterior tibial slope (PTS) may have higher risks of anterior cruciate ligament (ACL) reconstruction (ACL-R) failure, and clinical outcomes after revision of ACL-R procedures are typically poor.
This study aimed to perform a systematic review of the literature summarizing the clinical and radiological outcomes of the surgical treatment of ACL insufficiency in the setting of excessive PTS using a tibial deflexion osteotomy combined with ACL-R.
A systematic review of the literature was performed using PubMed, Cochrane Library, and OVID Medline databases from 1990 to present. Inclusion criteria were studies of outcomes of isolated tibial deflexion osteotomies performed with primary or revision ACL-R in the English language. Data extracted included study demographic information, type of tibial deflexion osteotomy and concomitant procedures, radiological outcomes, patient-reported outcome scores, and postoperative complications.
Six studies, with 133 knees were identified. All included studies were retrospective case series, with a weighted mean follow-up of 3.39 years. In 106 of 133 (79.7%) knees, tibial deflexion osteotomy was performed concomitantly with an ACL-R, whereas in 27 of 133 (20.3%) knees, the procedures were staged. 22, 45, and 66 of 133 knees (16.5%, 33.8%, and 49.6%) underwent primary, first revision, and second or greater revision ACL-R, respectively. Three of 133 (2.25%) knees demonstrated recurrent ACL graft failure at the final follow-up. On average, PTS decreased from 15.2° preoperatively to 7.1° postoperatively. The mean International Knee Documentation Committee, Lysholm, and Tegner scores increased from 42.5, 46.4, and 4.2 preoperatively to 71.8, 89.0, and 6.7 postoperatively.
The results of this review suggest that combined ACL-R and tibial deflexion osteotomy may be effective in decreasing PTS and improving knee function and stability.
Systematic Review; Level of evidence 4.
胫骨后倾角（PTS）过大的患者前交叉韧带（ACL）重建（ACL-R）失败的风险可能更高，且 ACL-R 后翻修手术的临床效果通常较差。
本研究旨在对文献进行系统回顾，总结使用胫骨后倾截骨术联合 ACL-R 治疗 PTS 过大的 ACL 功能不全的临床和影像学结果。
通过 PubMed、Cochrane 图书馆和 OVID Medline 数据库，从 1990 年至今进行了系统的文献回顾。纳入标准为使用胫骨后倾截骨术联合原发性或翻修 ACL-R 治疗的单独胫骨后倾截骨术的研究结果，这些研究为英文文献。提取的数据包括研究的人口统计学信息、胫骨后倾截骨术的类型和伴随的手术、影像学结果、患者报告的结果评分和术后并发症。
确定了 6 项研究，共 133 个膝关节。所有纳入的研究均为回顾性病例系列研究，加权平均随访时间为 3.39 年。在 133 个膝关节中的 106 个（79.7%）中，胫骨后倾截骨术与 ACL-R 同时进行，而在 133 个膝关节中的 27 个（20.3%）中，这些手术分期进行。在 133 个膝关节中，分别有 22、45 和 66 个膝关节（16.5%、33.8%和 49.6%）接受了初次、第一次翻修和第二次或更多次翻修 ACL-R。在最终随访时，3 个膝关节（2.25%）出现 ACL 移植物再失败。平均而言，PTS 从术前的 15.2°降至术后的 7.1°。国际膝关节文献委员会（International Knee Documentation Committee，IKDC）、Lysholm 和 Tegner 评分分别从术前的 42.5、46.4 和 4.2 增加到术后的 71.8、89.0 和 6.7。
本综述的结果表明，ACL-R 和胫骨后倾截骨术联合治疗可能有助于降低 PTS，并改善膝关节功能和稳定性。
系统回顾；证据水平 4。
