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[前交叉韧带断裂：重建时必须牢记什么？]

[Rupture of the anterior cruciate ligament : What must be born in mind in the reconstruction?].

作者信息

Fink Christian, Marchetti Andrea, Schwäblein Tobias, Herbort Mirco

机构信息

Gelenkpunkt - Sport und Gelenkchirurgie, Olympiastraße 39, 6020, Innsbruck, Österreich.

Research Unit für Sportmedizin des Bewegungsapparates und Verletzungsprävention, UMIT, Hall, Österreich.

出版信息

Unfallchirurgie (Heidelb). 2025 Apr;128(4):297-308. doi: 10.1007/s00113-025-01551-4. Epub 2025 Mar 19.

DOI:10.1007/s00113-025-01551-4
PMID:40105926
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11933175/
Abstract

Rupture of the anterior cruciate ligament (ACL) is a common sports injury. Despite continuous improvements over the years, not all patients return to their preoperative activities after treatment of the ACL. Therefore, individualized treatment approaches based on transplant selection, reconstruction technique and biomechanical factors, such as the tibial slope and rotational instability are crucial. Autogenous transplants have different properties in terms of donor site morbidity, healing behavior and risk of rerupture. The individual needs of the patient should therefore be taken into consideration. In terms of the surgical technique, correct tunnel placement based on anatomical landmarks is essential. In addition, concomitant instabilities and meniscus injuries must be addressed. In the event of a rerupture, an exact analysis of the causes is necessary. Ultimately, the success of the treatment depends to a large extent on precise diagnostics and the treatment of both the ACL rupture and any injured accompanying structures.

摘要

前交叉韧带（ACL）断裂是一种常见的运动损伤。尽管多年来不断改进，但并非所有患者在ACL治疗后都能恢复到术前的活动水平。因此，基于移植物选择、重建技术和生物力学因素（如胫骨坡度和旋转不稳定）的个体化治疗方法至关重要。自体移植物在供区发病率、愈合行为和再断裂风险方面具有不同的特性。因此，应考虑患者的个体需求。在手术技术方面，基于解剖标志正确放置隧道至关重要。此外，必须处理合并存在的不稳定和半月板损伤。如果发生再断裂，有必要对原因进行精确分析。最终，治疗的成功在很大程度上取决于精确的诊断以及对ACL断裂和任何伴随损伤结构的治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b040/11933175/7720350fff83/113_2025_1551_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b040/11933175/1c54f6064640/113_2025_1551_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b040/11933175/ffde11486d72/113_2025_1551_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b040/11933175/11fd41afd47f/113_2025_1551_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b040/11933175/6babaf61c5ce/113_2025_1551_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b040/11933175/e58f2220ce43/113_2025_1551_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b040/11933175/781410026581/113_2025_1551_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b040/11933175/7720350fff83/113_2025_1551_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b040/11933175/1c54f6064640/113_2025_1551_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b040/11933175/ffde11486d72/113_2025_1551_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b040/11933175/11fd41afd47f/113_2025_1551_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b040/11933175/6babaf61c5ce/113_2025_1551_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b040/11933175/e58f2220ce43/113_2025_1551_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b040/11933175/781410026581/113_2025_1551_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b040/11933175/7720350fff83/113_2025_1551_Fig7_HTML.jpg

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本文引用的文献

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Arthrosc Tech. 2024 Jul 27;14(1):103153. doi: 10.1016/j.eats.2024.103153. eCollection 2025 Jan.
2
Outcomes of Slope-Reducing Proximal Tibial Osteotomy Combined With a Third Anterior Cruciate Ligament Reconstruction Procedure With a Focus on Return to Impact Sports.胫骨近端截骨术联合第三前交叉韧带重建术治疗的结果分析，重点关注重返撞击性运动。
Am J Sports Med. 2023 Nov;51(13):3454-3463. doi: 10.1177/03635465231203016. Epub 2023 Oct 27.
3
Four to 6° Is the Target Posterior Tibial Slope After Tibial Deflection Osteotomy According to the Knee Static Anterior Tibial Translation.
根据膝关节静态胫骨前移情况，胫骨成角截骨术后胫后斜率目标为4至6°。
Arthroscopy. 2024 Mar;40(3):846-854. doi: 10.1016/j.arthro.2023.07.007. Epub 2023 Jul 19.
4
The "Bankart knee": high-grade impression fractures of the posterolateral tibial plateau lead to increased translational and anterolateral rotational instability of the ACL-deficient knee.“Bankart 膝”：后外侧胫骨平台的高级别压痕骨折导致 ACL 缺失膝关节的平移和前外侧旋转不稳定性增加。
Knee Surg Sports Traumatol Arthrosc. 2023 Oct;31(10):4151-4161. doi: 10.1007/s00167-023-07432-w. Epub 2023 May 8.
5
Current trends in graft choice for anterior cruciate ligament reconstruction - part I: anatomy, biomechanics, graft incorporation and fixation.前交叉韧带重建移植物选择的当前趋势——第一部分：解剖学、生物力学、移植物整合与固定
J Exp Orthop. 2023 Apr 1;10(1):37. doi: 10.1186/s40634-023-00600-4.
6
Extent of posterolateral tibial plateau impaction fracture correlates with anterolateral complex injury and has an impact on functional outcome after ACL reconstruction.胫骨平台后外侧骨块塌陷骨折的范围与前外侧复合体损伤相关，并对 ACL 重建后的功能结果有影响。
Knee Surg Sports Traumatol Arthrosc. 2023 Jun;31(6):2266-2273. doi: 10.1007/s00167-022-07282-y. Epub 2022 Dec 16.
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In elite athletes with meniscal injuries, always repair the lateral, think about the medial! A systematic review.在半月板损伤的精英运动员中，始终修复外侧半月板，考虑内侧半月板！系统评价。
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Medial Collateral Ligament Reconstruction: A Gracilis Tenodesis for Anteromedial Knee Instability.内侧副韧带重建：股薄肌腱固定术治疗膝前内侧不稳
Arthrosc Tech. 2022 Jul 14;11(8):e1409-e1418. doi: 10.1016/j.eats.2022.03.034. eCollection 2022 Aug.
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ACL stump and ACL femoral landmarks are equally reliable in ACL reconstruction for assisting ACL femoral tunnel positioning.ACL 残端和 ACL 股骨标志在 ACL 重建中对于辅助 ACL 股骨隧道定位同样可靠。
Knee Surg Sports Traumatol Arthrosc. 2023 Jan;31(1):219-228. doi: 10.1007/s00167-022-07084-2. Epub 2022 Aug 10.