腘绳肌腱自体移植物前交叉韧带重建术后残留的被动性胫骨前向半脱位：一项至少2年随访的纵向磁共振成像研究
简介
该研究通过MRI纵向追踪51例腘绳肌腱自体移植物ACL重建术后患者（术前及术后6、12、24个月），评估胫股对位关系的变化。关键发现：尽管所有患者术后24个月移植物完整性均获确认，但MRI显示外侧、内侧及整体被动胫骨前向半脱位（PATS）在术后12个月显著增加（分别增加1.5mm、1.2mm、1.4mm，p均<0.001），此后保持稳定。术前PATS程度、前…
英文摘要
PURPOSE: To track the 24-month longitudinal changes in tibiofemoral alignment characterised by passive anterior tibial subluxation (PATS) following anterior cruciate ligament reconstruction (ACLR), and to investigate associated factors. METHODS: Fifty-one patients who underwent primary ACLR using hamstring tendon autografts between March 2021 and February 2022 were enrolled. Clinical and magnetic resonance imaging (MRI) evaluations were performed at baseline (within 3 days preoperatively) and at 6-, 12- and 24-month follow-ups to examine the graft integrity and tibiofemoral alignment. Lateral PATS (L-PATS), medial PATS (M-PATS), global PATS (G-PATS) and rotational PATS (R-PATS) were measured on serial MRI. The repeated-measures one-way analysis of variance was applied to test the longitudinal changes in PATS. Univariable and multivariable linear regression analyses were performed to identify associations between preoperative and postoperative PATS, adjusting for a priori-defined covariates including time from injury to surgery, tibial slopes, meniscal injuries and anterolateral ligament (ALL) abnormality. RESULTS: The graft integrity was clinically and radiographically confirmed in all patients at the 24-month follow-up. However, serial MRI revealed significant increases in L-PATS, M-PATS and G-PATS (all p < 0.001) following the primary ACLR. The increases in L-PATS (1.5 mm, 95%CI [0.6,2.5], p < 0.001), M-PATS (1.2 mm, 95%CI [0.5,1.9], p < 0.001) and G-PATS (1.4 mm, 95%CI [0.6,2.1], p < 0.001) from baseline became the most prominent at 12 months and remained stable thereafter. Strong correlations were identified between preoperative and 24-month postoperative values for L-PATS (β = 0.60, p < 0.001), M-PATS (β = 0.43, p < 0.001), G-PATS (β = 0.48, p < 0.001) and R-PATS (β = 0.70, p < 0.001). ALL abnormality was associated with increased L-PATS (β = 1.85, p = 0.008) and G-PATS (β = 1.31, p = 0.009), while medial meniscal injury was associated with increased M-PATS (β = 1.12, p = 0.036) and G-PATS (β = 0.96, p = 0.048) measured at 24 months postoperatively. CONCLUSIONS: Residual tibiofemoral malalignment characterised by increased L-PATS, M-PATS and G-PATS persists following ACLR using hamstring tendon autografts. Excessive preoperative PATS, ALL abnormality and medial meniscal injury are associated with increased postoperative PATS. LEVEL OF EVIDENCE: Level IV.