Stone Jewel A, Tollefson Luke V, Shoemaker Evan P, LaPrade Robert F
Department of Research, Twin Cities Orthopedics, Edina, MN, USA.
University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA.
Ann Jt. 2024 Oct 30;9:42. doi: 10.21037/aoj-24-30. eCollection 2024.
Anterior cruciate ligament reconstruction (ACLR) failures occur for various reasons including residual laxity, untreated concomitant injuries, poor graft quality, and high tibial slope. Various additional procedures can help to decrease revision ACLR failures including anterolateral complex (ALC) procedures and slope-reducing osteotomies for patients with high tibial slopes. This narrative review aims to review the literature on the roles of ALC augmentation procedures and slope-reducing osteotomies in the setting of patients undergoing revision ACLRs.
A narrative review of relevant literature was performed in July 2024. Studies about anterolateral complex reconstructions and slope-reducing osteotomies in revision ACLRs were included.
The literature reported that lateral extra-articular tenodesis (LET) and anterolateral ligament reconstructions (ALLR) can be used in revision ACLR cases to significantly reduce clinical knee laxity and the risk of repeated graft failure. There is not currently a strong opinion on which ALC procedure is superior. There are reported slight differences in lateral knee pain and knee stiffness, but both similarly significantly improve clinical and functional outcomes. In revision ACLR cases that also have a high posterior tibial slope (PTS), a slope-reducing tibial osteotomy is warranted. An anterior closing wedge proximal tibial osteotomy (ACW-PTO) significantly reduces anterior tibial translation and graft failure. There is concern about the changes to patellar height, but the literature has found that such changes are either slight or absent by 6 months postoperatively.
The risk of ACLR failure is increased by risk factors like high tibial slope, preoperative knee laxity, and prior ACLR rupture. Anterolateral complex procedures and slope-reducing osteotomies may be used to address these specific concerns and reduce the risk of graft rupture. For revision ACLR cases with lower PTS, augmentation with a LET or an ALLR to reduce the risk of graft failure and improve rotational stability may be warranted. In the setting of a revision ACLR in patients with a high PTS of ≥12°, a concomitant ACW-PTO and ALC procedure should be considered to decrease the risk of an ACLR graft failure.
前交叉韧带重建（ACLR）失败的原因多种多样，包括残余松弛、未治疗的合并伤、移植物质量差以及胫骨坡度高。各种额外的手术有助于减少翻修ACLR的失败率，包括前外侧复合体（ALC）手术以及针对胫骨坡度高的患者进行的坡度降低截骨术。本叙述性综述旨在回顾关于ALC增强手术和坡度降低截骨术在接受翻修ACLR患者中的作用的文献。
于2024年7月进行了相关文献的叙述性综述。纳入了关于翻修ACLR中前外侧复合体重建和坡度降低截骨术的研究。
文献报道，外侧关节外腱固定术（LET）和前外侧韧带重建术（ALLR）可用于翻修ACLR病例，以显著降低临床膝关节松弛度和移植物再次失败的风险。目前对于哪种ALC手术更优尚无定论。据报道，膝关节外侧疼痛和膝关节僵硬存在轻微差异，但两者同样能显著改善临床和功能结果。在同时伴有高胫骨后坡度（PTS）的翻修ACLR病例中，有必要进行坡度降低胫骨截骨术。胫骨近端前闭合楔形截骨术（ACW - PTO）可显著减少胫骨前移和移植物失败。人们担心髌骨高度的变化，但文献发现术后6个月时此类变化轻微或无变化。
高胫骨坡度、术前膝关节松弛和既往ACLR破裂等风险因素会增加ACLR失败的风险。前外侧复合体手术和坡度降低截骨术可用于解决这些特定问题并降低移植物破裂的风险。对于PTS较低的翻修ACLR病例，可能有必要采用LET或ALLR进行增强以降低移植物失败风险并改善旋转稳定性。在PTS≥12°的高PTS患者进行翻修ACLR时，应考虑同时进行ACW - PTO和ALC手术以降低ACLR移植物失败的风险。
