联合翻修前交叉韧带重建与斜度矫正截骨术及外侧关节外肌腱固定术可改善胫骨后倾角度大及存在轴移的患者的稳定性。
Combined revision ACL reconstruction with slope-correction osteotomy and lateral extra-articular tenodesis improves stability in patients with high posterior tibial slope and pivot shift.
作者信息
Fritz Jesper, Getgood Alan, van Heerwaarden Ronald, Parratte Sebastien, Brown Charles, Tollefson Luke V, LaPrade Robert F
机构信息
International Knee and Joint Centre Abu Dhabi UAE.
Fowler Kennedy Sports Medicine Clinic London Ontario Canada.
出版信息
J Exp Orthop. 2025 Jul 24;12(3):e70384. doi: 10.1002/jeo2.70384. eCollection 2025 Jul.
PURPOSE
The purpose of this study was to evaluate the outcomes of patients undergoing single-stage revision anterior cruciate ligament (ACL) reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) autograft, anterior closing wedge proximal tibial osteotomy (ACWPTO) and lateral extra-articular tenodesis (LET).
METHODS
An institutional review board-approved retrospective study of all patients who underwent a revision ACLR using a BPTB autograft, ACWPTO and LET from a single centre from 2018 to 2023 was performed. Inclusion criteria were patients >18 years of age with a failed ACLR, posterior tibial slope (PTS) of >15°, previous ACL-tunnel diameters of <14 mm, and intact ipsilateral patellar tendon. PTS and anterior tibial translation (ATT) were measured using the mechanical axis on long weight-bearing lateral tibial radiographs.
RESULTS
Nine patients, all men, were evaluated with a mean age of 31.1 years and a mean follow-up of 31.4 months. The PTS significantly decreased from 16.8° (range: 15.1°-18.9°) preoperatively to 9.3° (range: 5.0°-14.7°) post-operatively ( < 0.001) and ATT significantly decreased from 14.6 mm (range: 10.7-19.0 mm) preoperatively to 6.3 mm (range: 1.3-11.5 mm) post-operatively (< 0.001). Preoperatively, all patients showed significant instability with the Lachman test Grade 2/3 and the pivot shift test Grade 2/3. Post-operatively, Lachman test grade was 0 and Pivot shift test grade was 0 in all patients ( < 0.01), and the average post-operative subjective International Knee Documentation Committee (IKDC) score was 79.4 (range: 60.9-95.4).
CONCLUSIONS
Single-stage revision ACLR using BPTB autograft, ACWPTO and LET in an ACL-deficient knee with high-grade pivot shift and increased PTS was safe and reliable, with significantly improved clinical and objective outcomes.
LEVEL OF EVIDENCE
Level IV, case series.
目的
本研究旨在评估采用骨-髌腱-骨（BPTB）自体移植物、胫骨近端前侧闭合楔形截骨术（ACWPTO）和外侧关节外肌腱固定术（LET）进行单阶段翻修前交叉韧带（ACL）重建（ACLR）的患者的治疗结果。
方法
对2018年至2023年在单一中心接受使用BPTB自体移植物、ACWPTO和LET进行翻修ACLR的所有患者进行了一项经机构审查委员会批准的回顾性研究。纳入标准为年龄大于18岁、ACLR失败、胫骨后倾（PTS）大于15°、既往ACL隧道直径小于14mm且同侧髌腱完整的患者。使用负重状态下的胫骨全长侧位X线片上的机械轴测量PTS和胫骨前移（ATT）。
结果
对9例男性患者进行了评估，平均年龄为31.1岁，平均随访31.4个月。PTS从术前的16.8°（范围：15.1°-18.9°）显著降至术后的9.3°（范围：5.0°-14.7°）（<0.001），ATT从术前的14.6mm（范围：10.7-19.0mm）显著降至术后的6.3mm（范围：1.3-11.5mm）（<0.001）。术前，所有患者的Lachman试验为2/3级、轴移试验为2/3级，均显示明显不稳定。术后，所有患者的Lachman试验分级为0级，轴移试验分级为0级（<0.01），术后主观国际膝关节文献委员会（IKDC）评分平均为79.4（范围：60.9-95.4）。
结论
在伴有高级别轴移和PTS增加的ACL缺失膝关节中，采用BPTB自体移植物、ACWPTO和LET进行单阶段翻修ACLR是安全可靠的，临床和客观结果均有显著改善。
证据级别
IV级，病例系列。
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