Lee Jeffrey, McCormick Johnathon R, Credille Kevin, Dandu Navya, Wang Zachary, Trasolini Nicholas A, Darwish Reem Y, Chahla Jorge, Yanke Adam B
Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, U.S.A.
Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A.
Arthrosc Sports Med Rehabil. 2025 Jan 15;7(2):101075. doi: 10.1016/j.asmr.2025.101075. eCollection 2025 Apr.
To assess the consistency of risk factor reporting for anterior cruciate ligament reconstruction (ACLR) failure after primary reconstruction, identify risk factors more frequently associated with ACLR failure, and help clinicians prevent reinjury in patients with risk factors for ACLR failure.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to conduct a systematic review. Initial title and abstract screening yielded 561 studies, from which 76 studies were assessed for eligibility. Thirty-two full-text studies met the following inclusion criteria: (1) clinical studies of anterior cruciate ligament injuries; (2) patients undergoing ACLR; (3) clinical outcome data, including failure rate; (4) studies assessing preoperative risk factors for failure; and (5) manuscripts published within the past 6 years. These studies were subdivided into those that defined ACLR failure as revision surgery or graft failure.
Ten risk factors were included in the review for 22 studies defining ACLR failure as revision surgery. Eight risk factors were included in the review for 10 studies defining ACLR failure as graft failure. Posterior tibial slope (PTS) (80%, 4/5 studies), age (79%, 11/14 studies), and graft characteristics (71%, 5/7 studies) such as allograft versus bone-patellar tendon-bone autograft, high-dose radiation, and BioCleanse preparation technique were the most significant risk factors for revision ACLR. PTS (100%, 2/2 studies) and activity level (67%, 2/3 studies) were the most significant risk factors for graft failure.
Age, PTS, use of allograft, and activity level are significant preoperative risk factors that should be considered when attempting to prevent reinjury in ACLR candidates. Studies investigating risk factors for ACLR failure often fail to control for confounding variables that can influence outcomes.
Level IV, systematic review of Level II to IV studies.
评估初次重建后前交叉韧带重建（ACLR）失败的危险因素报告的一致性，确定与ACLR失败更常相关的危险因素，并帮助临床医生预防有ACLR失败危险因素患者的再次损伤。
采用系统评价和Meta分析的首选报告项目指南进行系统评价。初步的标题和摘要筛选产生了561项研究，其中76项研究被评估是否符合纳入标准。32项全文研究符合以下纳入标准：（1）前交叉韧带损伤的临床研究；（2）接受ACLR的患者；（3）临床结局数据，包括失败率；（4）评估术前失败危险因素的研究；（5）过去6年内发表的手稿。这些研究被细分为将ACLR失败定义为翻修手术或移植物失败的研究。
对于22项将ACLR失败定义为翻修手术的研究，综述中纳入了10个危险因素。对于10项将ACLR失败定义为移植物失败的研究，综述中纳入了8个危险因素。后胫骨坡度（PTS）（80%，4/5研究）、年龄（79%，11/14研究）和移植物特征（71%，5/7研究），如同种异体移植物与骨-髌腱-骨自体移植物、高剂量辐射和BioCleanse制备技术，是翻修ACLR的最显著危险因素。PTS（100%，2/2研究）和活动水平（67%，2/3研究）是移植物失败的最显著危险因素。
年龄、PTS、同种异体移植物的使用和活动水平是重要的术前危险因素，在试图预防ACLR候选者再次损伤时应予以考虑。研究ACLR失败危险因素的研究往往未能控制可能影响结局的混杂变量。
IV级，对II至IV级研究的系统评价。
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