移植物直径不影响双束前交叉韧带重建的再破裂率或临床结果。

Graft diameter does not affect re-rupture rates or clinical outcomes in double-bundle anterior cruciate ligament reconstruction.

作者信息

Goto K, Iwaso H, Honda E, Sameshima S, Inagawa M, Ishida Y, Matsuo K, Kuzuhara R, Sanada T

机构信息

Department of Sports Orthopedic Surgery, Kanto Rosai Hospital, Kanagawa, Japan.

出版信息

Knee. 2025 Oct;56:178-186. doi: 10.1016/j.knee.2025.05.022. Epub 2025 May 30.

DOI:10.1016/j.knee.2025.05.022

PMID:40449293

Abstract

BACKGROUND

While a graft diameter of less than 8 mm is considered a risk factor for re-rupture in single-bundle anterior cruciate ligament reconstruction (ACLR), no studies have investigated the threshold for risk in double-bundle ACLR (DB-ACLR). This study aimed to evaluate the relationship between graft diameter and re-rupture rates in DB-ACLR.

METHODS

This study included 589 knees that underwent DB-ACLR with a minimum follow-up of 2 years. The total cross sectional area (CSA) of the grafts was calculated from the diameters of the anteromedial bundle (AMB) and posterolateral bundle (PLB). A restricted cubic spline regression model was applied to evaluate the relationship between total CSA and graft re-rupture. Although no statistically significant cutoff value was identified, the analysis suggested potential differences in re-rupture rates between knees with extremely small or large CSAs. Based on this finding, knees were classified into two groups: Group S (total CSA < 39 mm, corresponding to a single-bundle diameter < 7 mm) and Group L (total CSA > 50 mm, corresponding to a single-bundle diameter > 8 mm). Propensity score matching was conducted to adjust for confounding factors, including age, height, and weight, and re-rupture rates and Knee injury and Osteoarthritis Outcome Score (KOOS) were compared between the groups.

RESULTS

Graft re-rupture was observed in 37 out of 589 knees (6.3%). The mean graft diameter was 5.3 ± 0.4 mm for AMB, 5.0 ± 0.4 mm for PLB, and 41.5 ± 7.1 mm for total CSA. Restricted cubic spline regression analysis showed a slight decrease in the log odds of re-rupture with increasing CSA, but no significant cutoff value was identified, and the observed trend was not statistically significant. After propensity score matching, there were no significant differences in re-rupture rates (13.5% in Group S vs. 8.1% in Group L, p = 0.71) or KOOS scores between the groups.

CONCLUSION

In DB-ACLR, no clear cutoff value for graft diameter was identified, and total CSA was not a significant risk factor for re-rupture. Knees with small-diameter grafts demonstrated comparable re-rupture rates and KOOS scores to those with larger-diameter grafts.

LEVEL OF EVIDENCE

Level III.

摘要

背景

虽然在单束前交叉韧带重建术（ACLR）中，移植肌腱直径小于8毫米被认为是再次断裂的危险因素，但尚无研究调查双束ACLR（DB - ACLR）的风险阈值。本研究旨在评估DB - ACLR中移植肌腱直径与再次断裂率之间的关系。

方法

本研究纳入了589例接受DB - ACLR且至少随访2年的膝关节。根据前内侧束（AMB）和后外侧束（PLB）的直径计算移植肌腱的总横截面积（CSA）。应用受限立方样条回归模型评估总CSA与移植肌腱再次断裂之间的关系。虽然未确定具有统计学意义的临界值，但分析表明CSA极小或极大的膝关节之间再次断裂率可能存在差异。基于这一发现，将膝关节分为两组：S组（总CSA < 39平方毫米，相当于单束直径 < 7毫米）和L组（总CSA > 50平方毫米，相当于单束直径 > 8毫米）。进行倾向评分匹配以调整年龄、身高和体重等混杂因素，并比较两组之间的再次断裂率和膝关节损伤与骨关节炎疗效评分（KOOS）。

结果

589例膝关节中有37例（6.3%）观察到移植肌腱再次断裂。AMB的平均移植肌腱直径为5.3±0.4毫米，PLB为5.0±0.4毫米，总CSA为41.5±7.1平方毫米。受限立方样条回归分析显示，随着CSA增加，再次断裂的对数几率略有下降，但未确定显著的临界值，且观察到的趋势无统计学意义。倾向评分匹配后，两组之间的再次断裂率（S组为13.5%，L组为8.1%，p = 0.71）或KOOS评分无显著差异。