Department of Orthopedic Surgery, MacKay Memorial Hospital, Taipei City, Taiwan.
Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 333, Taiwan.
BMC Musculoskelet Disord. 2024 Aug 6;25(1):625. doi: 10.1186/s12891-024-07725-2.
Anterior cruciate ligament (ACL) graft failure is influenced by factors such as meniscal tears and tibial plateau slope. Combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction has reduced failure rates; however, its efficacy in high-risk patients remains unclear. This study hypothesized that combined ACL and ALL reconstruction would yield similar clinical outcomes in patients with varying risks of ACL failure.
A total of 76 patients who underwent primary single-bundle ACL reconstruction combined with ALL reconstruction between June 2018 and June 2021 were included. The medial tibial slope (MTS), lateral tibial slope (LTS), and anterior tibial translation (ATT) were measured using magnetic resonance imaging and plain radiography of the knee joint. The meniscal lesions were assessed during surgery. Preoperative clinical assessments and final follow-up were conducted using patient-reported outcome measurements (PROMs), including the International Knee Documentation Committee (IKDC) evaluation, Lysholm knee scoring scale, and Tegner Activity scale. PROMs were collected at least two years postoperatively.
The average follow-up was 32.5 ± 7.4 months. There were no significant differences in postoperative IKDC score, Lysholm score, or Tegner activity score between patients with or without medial meniscus injury (p = 0.155, 0.914, and 0.042, respectively), with or without lateral meniscus injury (p = 0.737, 0.569, and 0.942, respectively), medial tibial slope > 12° or ≤ 12° (p = 0.290, 0.496, and 0.988, respectively), or lateral tibial slope > 7.4° or ≤ 7.4° (p = 0.213, 0.625, and 0.922, respectively). No significant correlations were found between anterior tibial translation and postoperative IKDC (R = -0.058, p = 0.365), Lysholm (R = -0.017, p = 0.459), or Tegner activity scores (R = -0.147, p = 0.189).
Our study demonstrates that single-bundle ACL reconstruction combined with ALL reconstruction provides reliable and comparable clinical outcomes in patients with high-risk factors for ACL graft failure, such as increased tibial slope or meniscal injury. Our results suggest that the indications for ALL reconstruction may be expanded to include patients with a high tibial slope or meniscal injury, because these factors have been shown to contribute to increased rotational instability and high rates of ACL graft failure. Future prospective randomized controlled trials with large patient cohorts and long follow-up periods are needed to validate these findings and establish clear guidelines for patient selection and surgical decision-making.
Level 3.
前交叉韧带（ACL）移植物失效受半月板撕裂和胫骨平台斜率等因素影响。前交叉韧带（ACL）和前外侧韧带（ALL）联合重建可降低失效率；然而，其在高危患者中的疗效尚不清楚。本研究假设在 ACL 失效风险不同的患者中，ACL 和 ALL 联合重建将产生相似的临床结果。
共纳入 2018 年 6 月至 2021 年 6 月期间接受初次单束 ACL 重建联合 ALL 重建的 76 例患者。使用膝关节磁共振成像和普通 X 线片测量内侧胫骨斜率（MTS）、外侧胫骨斜率（LTS）和胫骨前移位（ATT）。术中评估半月板损伤。使用患者报告的结局测量（PROMs）进行术前临床评估和最终随访，包括国际膝关节文献委员会（IKDC）评估、Lysholm 膝关节评分量表和 Tegner 活动量表。至少在术后 2 年收集 PROMs。
平均随访 32.5±7.4 个月。内侧半月板损伤患者（p=0.155、0.914 和 0.042）、外侧半月板损伤患者（p=0.737、0.569 和 0.942）、MTS>12°或≤12°（p=0.290、0.496 和 0.988）或 LTS>7.4°或≤7.4°（p=0.213、0.625 和 0.922）的患者，术后 IKDC 评分、Lysholm 评分或 Tegner 活动评分之间无显著差异。胫骨前移位与术后 IKDC（R=-0.058，p=0.365）、Lysholm（R=-0.017，p=0.459）或 Tegner 活动评分（R=-0.147，p=0.189）无显著相关性。
本研究表明，ACL 单束重建联合 ALL 重建可为 ACL 移植物失效高危因素（如胫骨斜率增加或半月板损伤）的患者提供可靠且可比的临床结果。我们的结果表明，ALL 重建的适应证可能扩大到包括高胫骨斜率或半月板损伤的患者，因为这些因素与增加的旋转不稳定性和高 ACL 移植物失效率有关。需要未来有更大患者群体和更长随访期的前瞻性随机对照试验来验证这些发现，并为患者选择和手术决策制定明确的指南。
3 级。
