选择性外侧关节外肌腱固定术实现低前交叉韧带移植物断裂率，而胫骨后倾角和静态前向胫骨平移仍是主要危险因素
简介
该研究回顾性分析了2014-2018年间接受自体腘绳肌腱ACL重建的839例患者（随访705例，平均30.5岁，38%女性），其中成人根据轴移试验2-3级、关节过度松弛等指征选择性加做LET，18岁以下患者常规加做LET。平均随访6年，移植物破裂率为5.8%。成人组中，ACLR+LET组破裂率4.5%，单纯ACLR组5.4%（p=0.673）。多因素分析显示…
英文摘要
PURPOSE: This study aimed to evaluate anterior cruciate ligament (ACL) graft rupture in a selective approach to lateral extra-articular tenodesis (LET), with a focus on the impact of posterior tibial slope (PTS) and static anterior tibial translation (SATT) on graft rupture rate. METHODS: This retrospective study included patients who underwent primary ACL reconstruction (ACLR) using hamstrings autograft between 2014 and 2018, with a minimum follow-up of 6 years. LET was performed based on specific indications (pivot shift grade 2-3, hyperlaxity and genu recurvatum) in adult patients and systematically in those under 18 years of age. Demographic variables, associated procedures, ACL graft rupture and time to rupture were recorded. Preoperative radiographs were used to measure PTS and SATT. Univariate and multivariate analyses were performed to identify risk factors for graft rupture. RESULTS: A total of 839 patients were eligible. Follow-up was obtained for 705 patients (mean age 30.5 ± 10.9 years; 38% female). Forty-one ACL graft ruptures were identified (5.8%). Among adult patients (≥18 years), the graft rupture rate was 4.5% in the ACLR + LET group versus 5.4% in the isolated ACLR group (p = 0.673). Risk factors significantly associated with graft rupture included PTS ≥ 12° (odds ratio [OR] = 3.0; 95% confidence interval [CI] = 1.5-6.2; p = 0.001), SATT ≥ 5 mm (OR = 2.7; 95% CI = 1.3-5.5; p = 0.006), age < 18 years (OR = 2.3; 95% CI = 1.0-3.9; p = 0.017) and lateral meniscal injuries (OR = 2.3; 95% CI = 1.1-5.0; p = 0.041). The highest graft rupture rate occurred in patients <18 years with both PTS ≥ 12° and SATT ≥ 5 mm (2/7; 29%). CONCLUSIONS: A selective, indication-based approach to LET in patients ≥18 years and systematic LET in patients under 18 years of age was associated with low ACL graft rupture rates. Higher PTS, SATT, younger age and lateral meniscal injury were associated with an increased risk of graft rupture. These findings should be interpreted within the limitations of the study design. LEVEL OF EVIDENCE: Level III, retrospective case-control study.