Department of Orthopaedic Surgery, Fengfeng General Hospital of North China Medical & Health Group, Handan, Hebei, PR China.
Medicine (Baltimore). 2024 Aug 30;103(35):e39395. doi: 10.1097/MD.0000000000039395.
Many studies have reported the risk factors associated with primary anterior cruciate ligament (ACL) injury. However, few studies have focused on the bony morphology of secondary ipsilateral injury after ACL reconstruction. This study aimed to investigate the morphological risk factors of the proximal tibia contributing to secondary ipsilateral injury after ACL reconstruction. Twenty patients who were selected from secondary ipsilateral injury after ACL reconstruction between January 2015 and May 2020 were included in the secondary injury group. They were matched in a 1:2 ratio to the control group, which underwent primary ACL reconstruction during the same period and did not experience reinjury at the minimum 2-year follow-up, based on age, gender, and body mass index. All parameters, including medial tibial posterior slope, lateral tibial posterior slope (LTPS), medial tibial plateau depth, and lateral tibial plateau height, were recorded by using magnetic resonance imaging. Binary logistic regression analysis and receiver operator characteristic curves were conducted to explore the risk factors for reinjury and determine the cutoff value for the significant parameter. The LTPS was significantly larger in the secondary injury group than in the control group (9.6 ± 1.5° to 7.0 ± 1.4°, P < .001), and there was no significant difference in the medial tibial posterior slope, medial tibial posterior slope, and lateral tibial plateau height between the 2 groups (P > .05). The LTPS was found to be an independent risk factor for secondary ipsilateral injury after ACL reconstruction (odds ratio = 3.220, 95% confidence interval = 1.904-5.446, P < .001). The cutoff value of the LTPS was 8.8°, with a sensitivity of 91.7% and a specificity of 81.2%. The LTPS could be a unique predictor of secondary ipsilateral injury after ACL reconstruction. Orthopedists should implement effective measurements during primary reconstruction when the LTPS is >8.8°.
许多研究报告了与原发性前交叉韧带（ACL）损伤相关的风险因素。然而，很少有研究关注 ACL 重建后同侧二次损伤的骨形态学。本研究旨在探讨 ACL 重建后同侧二次损伤的胫骨近端形态学危险因素。
将 2015 年 1 月至 2020 年 5 月期间因 ACL 重建后同侧二次损伤而入选的患者纳入二次损伤组，根据年龄、性别和体重指数，将其与同期行初次 ACL 重建且至少 2 年随访未再受伤的患者以 1:2 的比例匹配到对照组。
使用磁共振成像记录内侧胫骨后倾角、外侧胫骨后倾角（LTPS）、内侧胫骨平台深度和外侧胫骨平台高度等参数。采用二元逻辑回归分析和受试者工作特征曲线探讨再损伤的危险因素，并确定有统计学意义的参数的截断值。
二次损伤组的 LTPS 明显大于对照组（9.6±1.5°比 7.0±1.4°，P<0.001），两组间内侧胫骨后倾角、内侧胫骨平台深度和外侧胫骨平台高度无显著差异（P>.05）。
LTPS 是 ACL 重建后同侧二次损伤的独立危险因素（比值比=3.220，95%置信区间=1.904-5.446，P<0.001）。LTPS 的截断值为 8.8°，其灵敏度为 91.7%，特异性为 81.2%。
LTPS 可能是 ACL 重建后同侧二次损伤的独特预测指标。当 LTPS>8.8°时，骨科医生应在初次重建时采取有效措施。
