Yoshida Ryu, Koga Hideyuki, Nakamura Tomomasa, Nakagawa Yusuke, Katakura Mai, Amemiya Masaki, Hoshino Takashi, Yoshihara Aritoshi, Hasegawa Shoichi, Tokumoto Yasumasa, Sekiya Ichiro, Ozeki Nobutake
Department of Joint Surgery and Sports Medicine Tokyo Medical and Dental University Bunkyo-ku, Tokyo Japan.
Department of Cartilage Regeneration Tokyo Medical and Dental University Tokyo Japan.
J Exp Orthop. 2024 Aug 28;11(3):e70011. doi: 10.1002/jeo2.70011. eCollection 2024 Jul.
Delayed anterior cruciate ligament (ACL) reconstruction often causes residual anterolateral rotatory instability (ALRI) and consequent knee osteoarthritis, warranting the recommendation of early ACL reconstruction within 6 months after injury. Nonetheless, some cases show notable instability, even shortly after injury. The purpose of this study was to identify risk factors for an increase in quantitatively measured pivot shift in patients with ACL-deficient knees within 6 months after injury.
Patients with primary ACL reconstruction within 6 months after injury and quantitative triaxial accelerometer measurements of preoperative pivot shift were included. Descriptive statistics were calculated for 11 independent variables (age, gender, time from injury to surgery, KT-1000, knee extension angle, lateral and medial posterior tibial slope angle, medial and lateral meniscus tears, ramp lesion and Tegner active scale). A single regression analysis was performed on the 11 items and acceleration during the pivot shift, and a multiple regression analysis was performed for items with value less than 0.1.
Overall, 111 patients met the inclusion criteria. Single regression analysis showed that medial posterior tibial slope angle, medial meniscus tear and ramp lesion were significantly correlated with acceleration during the pivot shift ( < 0.001, = 0.04 and = 0.001). Multiple regression analysis identified medial posterior tibial slope angles and ramp lesions as independent factors for increased preoperative pivot shift ( = 0.005 and 0.01).
A steep medial posterior tibial slope angle and ramp lesion were independent risk factors for increased quantitatively measured pivot shift in patients with ACL-deficient knees.
Level IV, case series study.
前交叉韧带（ACL）重建延迟常导致残留的前外侧旋转不稳定（ALRI）以及随之而来的膝关节骨关节炎，因此建议在受伤后6个月内尽早进行ACL重建。尽管如此，一些病例即使在受伤后不久也表现出明显的不稳定。本研究的目的是确定受伤后6个月内ACL损伤膝关节患者定量测量的轴移增加的危险因素。
纳入受伤后6个月内进行初次ACL重建且术前采用定量三轴加速度计测量轴移的患者。对11个独立变量（年龄、性别、受伤至手术的时间、KT-1000、膝关节伸展角度、胫骨后内侧和外侧坡度角、内侧和外侧半月板撕裂、斜行损伤和Tegner活动量表）进行描述性统计。对这11项指标与轴移过程中的加速度进行单因素回归分析，对P值小于0.1的指标进行多因素回归分析。
总体而言，111例患者符合纳入标准。单因素回归分析显示，胫骨后内侧坡度角、内侧半月板撕裂和斜行损伤与轴移过程中的加速度显著相关（P<0.001、P=0.04和P=0.001）。多因素回归分析确定胫骨后内侧坡度角和斜行损伤是术前轴移增加的独立因素（P=0.005和0.01）。
胫骨后内侧坡度角陡峭和斜行损伤是ACL损伤膝关节患者定量测量的轴移增加的独立危险因素。
IV级，病例系列研究。
