Nakamae Atsuo, Fujimoto Eisaku, Nakamura Mitsuhiro, Takada Tsuyoshi, Tsuyuguchi Yusuke, Kano Toshiya, Nekomoto Akinori, Adachi Nobuo
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan.
Department of Orthopedic Surgery Chugoku Rosai Hospital Hiroshima Japan.
J Exp Orthop. 2025 May 12;12(2):e70265. doi: 10.1002/jeo2.70265. eCollection 2025 Apr.
To investigate the factors affecting residual pivot shift after anterior cruciate ligament (ACL) reconstruction.
This multicentre prospective cohort study included patients who underwent primary ACL reconstruction using an autologous hamstring tendon graft with or without the ACL remnant-preserving technique. Multivariable logistic regression analysis was conducted to identify the factors that influenced residual pivot shift 1 year after ACL reconstruction. Age, sex, body mass index, interval between injury and surgery, preoperative pivot-shift grade, side-to-side differences in anterior knee laxity, hyperextension, lateral and medial meniscus treatments, and ACL reconstruction procedure (remnant-sacrificing single-bundle reconstruction, remnant-sacrificing double-bundle reconstruction or remnant-preserving single-bundle reconstruction) were selected as independent variables in the multivariable model. Patients who underwent additional lateral extra-articular tenodesis or anterolateral ligament reconstruction were excluded.
A total of 760 patients, including 394 males and 366 females (average age at surgery, 29.1 years; age range, 14-67 years), were enroled in this study. The postoperative side-to-side difference in anterior knee laxity was 0.8 ± 2.3 mm, and pathological positive results in the pivot-shift test 1 year after ACL reconstruction were observed in 95 patients (12.5%). Factors that significantly affected postoperative positive pivot-shift test results were younger age (odds ratio [OR] 1.71; = 0.033), medial meniscectomy (OR, 3.48; < 0.001), remnant-sacrificing single-bundle reconstruction (OR, 3.54; < 0.001) and remnant-sacrificing double-bundle reconstruction (OR, 2.18; = 0.034).
Younger age, medial meniscectomy and remnant-sacrificing ACL reconstruction techniques were associated with residual pivot shift 1 year after ACL reconstruction. Identifying risk factors for postoperative residual pivot-shift is important for optimizing treatment decisions.
Level II.
探讨影响前交叉韧带（ACL）重建术后残留轴移的因素。
这项多中心前瞻性队列研究纳入了使用自体腘绳肌腱移植物进行初次ACL重建的患者，采用或不采用保留ACL残端技术。进行多变量逻辑回归分析，以确定影响ACL重建术后1年残留轴移的因素。年龄、性别、体重指数、受伤与手术间隔时间、术前轴移分级、膝关节前侧松弛度的左右差异、膝关节过伸、外侧和内侧半月板处理情况以及ACL重建手术方式（牺牲残端单束重建、牺牲残端双束重建或保留残端单束重建）被选为多变量模型中的自变量。接受额外外侧关节外肌腱固定术或前外侧韧带重建术的患者被排除。
本研究共纳入760例患者，其中男性394例，女性366例（手术平均年龄29.1岁；年龄范围14 - 67岁）。术后膝关节前侧松弛度的左右差异为0.8±2.3mm，95例患者（12.5%）在ACL重建术后1年的轴移试验中病理结果呈阳性。显著影响术后轴移试验阳性结果的因素包括年龄较小（比值比[OR]1.71；P = 0.033）、内侧半月板切除术（OR，3.48；P < 0.001）、牺牲残端单束重建（OR，3.54；P < 0.001）和牺牲残端双束重建（OR，2.18；P = 0.034）。
年龄较小、内侧半月板切除术和牺牲残端的ACL重建技术与ACL重建术后1年的残留轴移有关。识别术后残留轴移的危险因素对于优化治疗决策很重要。
二级。
