Mazy David, Cance Nicolas, Favroul Clement, Angelelli Lucia, Beckers Gautier, Dan Michael J, Dejour David H
Lyon Ortho Clinic, Orthopedic Surgery Department, Clinique de la Sauvegarde, Lyon, France.
Department of Orthopaedic Surgery, Klinikum Grobhardern, Ludwig-Maximilians-University of Munich, Munich, Germany.
Am J Sports Med. 2025 Jun 30:3635465251350397. doi: 10.1177/03635465251350397.
BACKGROUND: The addition of a lateral extra-articular tenodesis (LET) to anterior cruciate ligament (ACL) reconstruction (ACLR) has been shown to reduce ACL graft rupture rates. Posterior tibial slope (PTS) and static anterior tibial translation (SATT) are also recognized as risk factors for ACL graft rupture. PURPOSE/HYPOTHESIS: The purpose was to evaluate the effect of PTS and SATT on graft rupture rates after ACLR using hamstring tendon autografts combined with LET. It was hypothesized that increased PTS and SATT would result in increased ACL graft rupture rates despite the addition of an LET. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: This retrospective, single-center, single-surgeon study included patients who underwent primary ACLR with hamstring tendon autografts combined with LET between January 2014 and December 2017. Demographic data were collected, and the association between PTS, SATT, and ACL graft rupture rates was assessed with a minimum follow-up of 6 years. Subgroup analyses were performed using PTS thresholds of 9° and 12°, as well as an SATT threshold of 5 mm. Univariate and multivariate analyses were conducted to identify significant risk factors for ACL graft rupture. RESULTS: Of the 934 ACLR procedures performed, 207 patients met the inclusion criteria. With a 90% response rate, 186 patients who underwent primary ACLR with hamstring tendon autografts and LET were included for analysis. ACL graft rupture rate for patients with a PTS ≥12° (19.4%) was significantly ( < .001) higher than that for patients with PTS <12° (2.7%). The highest ACL graft rupture rate (26%) was observed in patients with both a PTS ≥12° and an SATT ≥5 mm. Patients with a PTS <9° demonstrated no ACL graft ruptures (0/60). The risk of graft rupture was significantly associated with a PTS ≥12° (OR, 12; 95% CI, 0.1-0.4; < .001), SATT ≥5 mm (OR, 1.4; 95% CI, 0.2-3; = .045), and age <18 years (OR, 4.1; 95% CI, 0.8-22.1; = .015). CONCLUSION: Despite the addition of an LET, almost 20% of patients undergoing ACLR with hamstring tendon autografts experienced graft rupture when PTS was ≥12°. When combined with an increased SATT (≥5 mm), the graft rupture rate rose to 26%. In contrast, no graft ruptures were observed in patients with a PTS <9°. These findings emphasize the importance of evaluating PTS and SATT individually rather than systematically performing LET.
背景：在重建前交叉韧带（ACLR）时增加外侧关节外肌腱固定术（LET）已被证明可降低ACL移植物破裂率。胫骨后倾（PTS）和静态胫骨前移（SATT）也被认为是ACL移植物破裂的危险因素。 目的/假设：目的是评估PTS和SATT对使用腘绳肌腱自体移植物联合LET进行ACLR后移植物破裂率的影响。假设尽管增加了LET，但PTS和SATT的增加仍会导致ACL移植物破裂率增加。 研究设计：病例对照研究；证据等级，3级。 方法：这项回顾性、单中心、单术者研究纳入了2014年1月至2017年12月期间接受腘绳肌腱自体移植物联合LET进行初次ACLR的患者。收集人口统计学数据，并评估PTS、SATT与ACL移植物破裂率之间的关联，最短随访6年。使用9°和12°的PTS阈值以及5 mm的SATT阈值进行亚组分析。进行单因素和多因素分析以确定ACL移植物破裂的显著危险因素。 结果：在934例ACLR手术中，207例患者符合纳入标准。回复率为90%，186例接受腘绳肌腱自体移植物和LET进行初次ACLR的患者纳入分析。PTS≥12°的患者的ACL移植物破裂率（19.4%）显著高于（<.001）PTS<12°的患者（2.7%）。在PTS≥12°且SATT≥5 mm的患者中观察到最高的ACL移植物破裂率（26%）。PTS<9°的患者未出现ACL移植物破裂（0/60）。移植物破裂风险与PTS≥12°（OR，12；95%CI，0.1 - 0.4；<.001）、SATT≥5 mm（OR，1.4；95%CI，0.2 - 3；=.045）和年龄<18岁（OR，4.1；95%CI，0.8 - 22.1；=.015）显著相关。 结论：尽管增加了LET，但当PTS≥12°时，近20%接受腘绳肌腱自体移植物进行ACLR的患者发生了移植物破裂。当与增加的SATT（≥5 mm）相结合时，移植物破裂率升至26%。相比之下，PTS<9°的患者未观察到移植物破裂。这些发现强调了单独评估PTS和SATT的重要性，而不是系统性地进行LET。
Arch Orthop Trauma Surg. 2025-7-17
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