前交叉韧带撕裂合并外侧半月板后根撕裂患者出现高度轴移的危险因素：系统综述与Meta分析
简介
该荟萃分析纳入20项研究、8102例患者，评估前交叉韧带（ACL）合并外侧半月板后根撕裂（LMPRT）患者出现高度轴移（high-grade pivot shift）的发生率及危险因素。结果显示：单纯ACL撕裂患者高度轴移发生率为46%，合并LMPRT者升至72%。独立危险因素包括：年龄较小、KT-SSD值升高、胫骨前移增加、关节松弛、半月板严重挤压、外侧胫…
英文摘要
OBJECTIVE: High-grade pivot shift is the most common complication in patients with anterior cruciate ligament (ACL) tears combined with lateral meniscus posterior root tears (LMPRT), and it significantly impairs quality of life. Risk factors for high-grade pivot shift in this patient population have not been fully investigated. This meta-analysis aims to evaluate the incidence and risk factors of high-grade pivot shift in these patients to provide evidence-based guidance for clinical treatment. METHODS: We searched for observational studies investigating high-grade pivot shift in patients with ACL tears combined with LMPRT in PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and SinoMed from the inception of each database through November 2025, using a combination of MeSH terms and free-text keywords. Basic study characteristics, incidence of high-grade pivot shift, and relevant risk factors were extracted from included studies. Methodological quality and risk of bias were assessed, and meta-analysis of incidence rates and risk factors was performed using Stata 18.0 software. RESULTS: A total of twenty studies involving 8,102 patients were included. High-grade pivot shift was identified in 46% of patients with isolated ACL tears (95% CI: 0.26, 0.65) and in 72% of those with ACL tears combined with LMPRT (95% CI: 0.54, 0.89). Nineteen of the included studies were rated as high quality. Younger age (MD = -0.13, 95% CI: -0.19 to -0.06), elevated KT-SSD (MD = 0.77, 95%CI: 0.28-1.26; OR = 5.13, 95%CI: 3.01-8.74), increased anterior tibial translation (MD = 0.90, 95%CI: 0.23 to 1.58), joint laxity (OR = 1.78, 95%CI: 1.03-3.08), severe meniscal extrusion (MD = 1.51, 95%CI: 0.52-2.49), increased lateral tibial slope (MD = 0.15, 95%CI: 0.03-0.26), and complete meniscal tear (OR = 5.01, 95%CI: 2.89-8.66) were independent risk factors for high-grade pivot shift in patients with ACL tear combined with LMPRT. CONCLUSION: Younger age, elevated KT-SSD values, increased anterior tibial translation, joint laxity, severe meniscal extrusion, increased lateral tibial slope, and complete meniscal tear are independent risk factors for high-grade pivot shift in patients with ACL tear combined with LMPRT. Patients with these high-risk factors require enhanced follow-up and timely intervention to reduce the incidence of high-grade pivot shift and improve patients' quality of life. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/home, identifier CRD420251269936.