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重复翻修前交叉韧带重建对骨科医生来说仍然是一项挑战。

Repeat Revision Anterior Cruciate Ligament Reconstruction Remains a Challenge for Orthopedic Surgeons.

作者信息

Rodriguez-Merchan E Carlos

机构信息

Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain.

出版信息

Arch Bone Jt Surg. 2025;13(2):114-118. doi: 10.22038/ABJS.2024.76809.3549.

Abstract

The re-revision of anterior cruciate ligament reconstruction (ACLR) can be contemplated a secure and efficacious surgical technique with good results, whether it is performed in one-stage or two-stages or is performed with autograft or allograft. With regard to the surgical technique, there is no evidence that performing ACLR in one stage is superior to performing it in two stages. With respect to graft choice, allograft is the most chosen, and the allograft most frequently utilized is the Achilles tendon. However, the best graft to use for re-revision is not yet known. For revision ACLR orthopedic surgeons have to contemplate the amendment of an outrageous posterior tibial slope, especially after having failed two or more consecutive interventions. The potential benefit of combining ACLR with an anterolateral ligament reconstruction is to achieve greater rotational stability. It will diminish both the elevated failure percentages observed specifically in young individuals and increasing osteoarthritic changes encountered following sole ACLR.

摘要

前交叉韧带重建术(ACLR)的再次翻修术,无论采用一期手术还是二期手术,也无论使用自体移植物还是同种异体移植物,都可被视为一种安全有效的手术技术,效果良好。关于手术技术,没有证据表明一期进行ACLR优于二期进行。在移植物选择方面,同种异体移植物是最常选用的,最常用的同种异体移植物是跟腱。然而,用于再次翻修的最佳移植物尚不清楚。对于翻修性ACLR,骨科医生必须考虑矫正异常的胫骨后倾坡度,尤其是在连续两次或更多次干预失败后。将ACLR与前外侧韧带重建相结合的潜在益处是实现更大的旋转稳定性。这将降低特别是在年轻人中观察到的较高失败率,以及减少单纯ACLR后出现的日益增多的骨关节炎变化。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2554/11836797/88ae79696e05/ABJS-13-114-g001.jpg

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