冠状位力线增加体外ACL应变，但与移植物失败缺乏一致的临床关联：一项系统综述
简介
本系统综述评估了冠状位内翻/外翻力线对前交叉韧带（ACL）初次断裂及移植物失败的影响。纳入13项研究（4项尸体生物力学、9项临床）。生物力学证据显示，机械轴偏移（无论外翻或内翻）均增加ACL或移植物应变（较中立位增加11%-72%），其中外翻风险更高。但临床证据不一致：部分研究显示ACL损伤肢体外翻角更大，另一些则未发现差异；内翻力线与移植物成熟度较差相关。…
英文摘要
PURPOSE: The purpose of this systematic review was to evaluate the existing literature on the impact of radiographic varus/valgus alignment on primary ACL rupture and graft failure. METHODS: Three online databases (PubMed, Embase and Cochrane Library) were searched for the period of database inception until 31 July 2025. All clinical, biomechanical, or computational investigations assessing the influence of bony coronal plane alignment on primary ACL rupture/graft rupture were included. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) for clinical studies and Quality Appraisal for Cadaveric Studies (QUACS) scale for biomechanical studies. RESULTS: Thirteen studies met inclusion criteria: four cadaveric (38 specimens) and nine clinical investigations. Cadaveric studies demonstrated a biomechanical disadvantage of mechanical axis deviation, with both excessive valgus and varus alignment increasing native ACL or ACL graft strain in vitro (11%-72% increase relative to neutral alignment). Up to 72% increased graft strain was observed with increased valgus alignment, suggesting valgus may pose greater biomechanical risk than varus. Conversely, clinical evidence for coronal malalignment as a risk factor for ACL rupture or ACL graft rupture was inconsistent. Some studies reported increased valgus alignment in ACL-injured versus uninjured limbs, while others found no differences in either primary or revision ACL reconstruction setting. An association between greater varus alignment and inferior graft maturation was suggested. CONCLUSION: While biomechanical evidence indicates that both varus and valgus coronal malalignment increase ACL strain, the corresponding clinical evidence for its association with ACL rupture or ACL graft rupture remains limited. Based on the synthesis of data, preliminary thresholds of >5° valgus and >8° varus merit investigation as potential risk factors for ACL rupture/graft rupture. Given the lack of literature on this topic, further investigation is required to determine the effect of coronal malalignment on risk of ACL rupture and clinical thresholds that merit additional surgical intervention. LEVEL OF EVIDENCE: Level IV.