Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
JBJS Rev. 2024 Jul 17;12(7). doi: e24.00047. eCollection 2024 Jul 1.
» The rate of primary anterior cruciate ligament reconstruction (ACLR) failure in at-risk populations remains unacceptably high and necessitates thorough evaluation of native alignment and concomitant injuries.» Posterior tibial slope of >12° is a substantial risk factor of ACLR failure and should be corrected through anterior closing wedge osteotomy.» Varus malalignment of >5° exacerbates stress on the ACL graft, increases ACLR failure risks, and should be considered for correction through high tibial osteotomy at the time of revision ACLR.» Injuries to the anterolateral ligamentous complex are prevalent in ACL ruptures, and high-risk patients have shown benefit from anterolateral ligament reconstruction or lateral extra-articular tenodesis in the revision setting.» Addressing posterolateral corner, collateral ligament, and meniscal injuries, during revision ACLR, is vital to mitigate increased graft forces and optimize knee stability and functional outcomes.
»高危人群中初次前交叉韧带重建（ACLR）失败的发生率仍然高得令人无法接受，因此需要对原始对线和伴随损伤进行彻底评估。»>12°的胫骨后倾角是 ACLR 失败的一个重要危险因素，应通过前闭楔形骨切开术进行矫正。»>5°的内翻畸形会加剧 ACL 移植物的应力，增加 ACLR 失败的风险，应考虑在 revision ACLR 时通过胫骨高位截骨术进行矫正。»>前外侧韧带复合体损伤在 ACL 断裂中很常见，高危患者在前交叉韧带重建或外侧关节外肌腱固定术的翻修中受益。»>在 revision ACLR 中处理后外侧角、侧副韧带和半月板损伤对于减轻移植物受力增加、优化膝关节稳定性和功能结果至关重要。
