Hughes Jonathan D, Boden Stephanie A, Belayneh Rebekah, Dvorsky Jenna, Mirvish Asher, Godshaw Brian, Sansone Mikael, Karlsson Jon, Musahl Volker
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA.
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Orthop J Sports Med. 2024 Aug 20;12(8):23259671241263883. doi: 10.1177/23259671241263883. eCollection 2024 Aug.
Smaller intercondylar notch sizes have been consistently associated with a predisposition for primary anterior cruciate ligament tears.
To evaluate the association between intercondylar notch size, graft size, and postoperative complications, including knee stiffness and return to the operating room, after primary anatomic anterior cruciate ligament reconstruction (ACLR).
Case-control study; Level of evidence, 3.
This was a retrospective analysis of prospectively collected data from consecutive patients who underwent anatomic single-bundle primary ACLR using a bone-patellar tendon-bone or quadriceps tendon autograft performed by fellowship-trained orthopaedic sports medicine surgeons between April 2009 and August 2019. Graft failure was defined as patient report of instability, pathologic laxity on clinical examination, or graft rerupture confirmed by magnetic resonance imaging and/or subsequent arthroscopy. To ensure the purposeful selection of covariates, univariate analyses were conducted on the list of potential confounders selected a priori, and those with a significance value of < .10 were considered for the multivariate regression model. Covariates found to be statistically significant with univariate analysis were patient age, notch size, and graft type. After validating all potential covariates, they were added to the regression model and then eliminated in a stepwise fashion.
In total, 252 patients were included for analysis (99 bone-patellar tendon-bone and 153 quadriceps tendon autograft; age, 22.2 ± 7.0 years; graft size, 9.8 ± 1.0 mm; time to follow-up, 50.4 ± 28.9 months). Knee stiffness developed in 23 patients (9.1%), and 15 grafts failed (6.0%). Smaller notch size on magnetic resonance imaging was significantly associated with graft failure ( = .005). There was a significantly higher risk of graft failure with notch size <16 versus ≥16 mm (17.6% vs 2.3%; = .005) with an odds ratio (OR) of 5.0 (95% CI, 1.7-15.1; = .004). Notch size <15 mm was associated with the highest risk of graft failure (22.2%; OR, 5.8; 95% CI, 1.6-20.6; = .006). There was no significant association between notch size or graft-notch size ratio and knee stiffness, meniscal injury, or cartilage damage at the time of ACLR, regardless of graft type.
Intercondylar notch size <16 mm was associated with a 5-fold increased risk of graft failure after primary anatomic ACLR.
髁间切迹尺寸较小一直与原发性前交叉韧带撕裂的易感性相关。
评估原发性解剖学前交叉韧带重建（ACLR）术后髁间切迹尺寸、移植物尺寸与术后并发症（包括膝关节僵硬和重返手术室）之间的关联。
病例对照研究；证据等级，3级。
这是一项对前瞻性收集数据的回顾性分析，研究对象为2009年4月至2019年8月间由接受过专科培训的骨科运动医学外科医生采用骨-髌腱-骨或股四头肌肌腱自体移植物进行解剖单束原发性ACLR的连续患者。移植物失败定义为患者报告的不稳定、临床检查时的病理性松弛或磁共振成像和/或后续关节镜检查证实的移植物再次断裂。为确保有目的地选择协变量，对预先选定的潜在混杂因素列表进行单变量分析，显著性值<0.10的因素被纳入多变量回归模型。单变量分析发现具有统计学意义的协变量为患者年龄、切迹尺寸和移植物类型。在验证所有潜在协变量后，将它们添加到回归模型中，然后逐步剔除。
总共纳入252例患者进行分析（99例骨-髌腱-骨和153例股四头肌肌腱自体移植物；年龄，22.2±7.0岁；移植物尺寸，9.8±1.0mm；随访时间，50.4±28.9个月）。23例患者（9.1%）出现膝关节僵硬，15例移植物失败（6.0%）。磁共振成像显示较小的切迹尺寸与移植物失败显著相关（P = 0.005）。切迹尺寸<16mm与≥16mm相比，移植物失败风险显著更高（17.6%对2.3%；P = 0.005），优势比（OR）为5.0（95%CI，1.7 - 15.1；P = 0.004）。切迹尺寸<15mm与移植物失败风险最高相关（22.2%；OR，5.8；95%CI，1.6 - 20.6；P = 0.006）。无论移植物类型如何，ACLR时切迹尺寸或移植物-切迹尺寸比与膝关节僵硬、半月板损伤或软骨损伤之间均无显著关联。
髁间切迹尺寸<16mm与原发性解剖学ACLR术后移植物失败风险增加5倍相关。
