Schmidt Sebastian, Leite Chilan Bou Ghosson, Bumberger Alexander, Franco Domenico, Jacobs Cale Andrew, Richardson Lars, Paschos Nikolaos, Goertz Simon, Berkson Eric, Asnis Peter, Lattermann Christian
University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
Brigham and Women's Hospital, Boston, MA, USA.
Int Orthop. 2025 Aug 7. doi: 10.1007/s00264-025-06632-y.
Ehlers-Danlos Syndrome (EDS) is a connective tissue disorder characterized by joint hypermobility, ligamentous laxity, and frequent joint injuries. These features could increase the risk of anterior cruciate ligament (ACL) tears, typically managed through ACL reconstruction (ACLR). Surgical intervention in EDS is challenging due to potential complications such as poor wound healing and tissue fragility. Limited evidence exists regarding the outcomes of ACLR in EDS patients; therefore, in this study we aimed to evaluate survival rates of primary and revision ACLR and examine associated demographic and anatomic risk factors for failure after ACLR.
A retrospective review of 21 EDS patients (25 knees) who underwent ACLR between 1993 and 2023 was conducted. Patients with vascular EDS were excluded. Demographic and surgical data, including graft type, cause of injury, concomitant procedures such as meniscus repair and anatomical measurements (posterior tibial slope, intercondylar notch width, lateral femoral condyle morphology, tibiofemoral rotation and tibial tubercle- trochlear groove distance), were collected. Survival analysis was performed using Kaplan-Meier curves, with endpoints defined as ACLR failure or conversion to total knee arthroplasty (TKA). A multivariable survival analysis was used to identify predictors of outcomes. In addition, the influence of demographic and anatomical factors on the development of concomitant injuries and concomitant procedures were assessed. Anatomical factors were then compared with non-EDS patients from the existing literature.
The overall survival rate was 85.7% at mean follow-up of 50 months. Primary ACLR showed significantly higher survival rates 93.8% compared to revision ACLR 62.5% at 50 months (p = 0.03). Sports injuries, particularly skiing, were the leading cause of ACL tears (62%). Anatomical differences, such as increased lateral femoral condyle ratio (LFCR) and tibiofemoral rotation (TFR), were observed compared to non-EDS, ACL-intact patients from the literature (p < 0.01). However, these factors did not predict failure or influence concomitant injuries.
This study demonstrates that ACLR in EDS patients achieves good survival rates. Anatomical risk factors differed significantly from non-EDS, ACL-intact patients, but were not predictive of failure, highlighting ligamentous laxity as the primary challenge.
埃勒斯-当洛综合征（EDS）是一种结缔组织疾病，其特征为关节活动过度、韧带松弛和频繁的关节损伤。这些特征可能会增加前交叉韧带（ACL）撕裂的风险，ACL撕裂通常通过ACL重建术（ACLR）进行治疗。由于存在伤口愈合不良和组织脆弱等潜在并发症，对EDS患者进行手术干预具有挑战性。关于EDS患者ACLR结果的证据有限；因此，在本研究中，我们旨在评估初次和翻修ACLR的生存率，并检查ACLR失败相关的人口统计学和解剖学风险因素。
对1993年至2023年间接受ACLR的21例EDS患者（25个膝关节）进行回顾性研究。排除患有血管型EDS的患者。收集人口统计学和手术数据，包括移植物类型、损伤原因、半月板修复等伴随手术以及解剖学测量数据（胫骨后倾角、髁间窝宽度、股骨外侧髁形态、胫股旋转和胫骨结节-滑车沟距离）。使用Kaplan-Meier曲线进行生存分析，终点定义为ACLR失败或转换为全膝关节置换术（TKA）。采用多变量生存分析来确定结果的预测因素。此外，评估人口统计学和解剖学因素对伴随损伤和伴随手术发生的影响。然后将解剖学因素与现有文献中的非EDS患者进行比较。
平均随访50个月时，总体生存率为85.7%。初次ACLR在50个月时的生存率为93.8%，显著高于翻修ACLR的62.5%（p = 0.03）。运动损伤，尤其是滑雪，是ACL撕裂的主要原因（62%）。与文献中未患EDS且ACL完整的患者相比，观察到解剖学差异，如股骨外侧髁比率（LFCR）增加和胫股旋转（TFR）增加（p < 0.01）。然而，这些因素并不能预测失败或影响伴随损伤。
本研究表明，EDS患者的ACLR具有良好的生存率。解剖学风险因素与未患EDS且ACL完整的患者有显著差异，但不能预测失败，这突出了韧带松弛是主要挑战。
