前交叉韧带重建进展：2026年风险分层、移植物选择与功能恢复
简介
本文综述了2023-2026年前交叉韧带重建（ACLR）领域的最新进展，聚焦于风险分层、移植物选择、手术规划及康复策略的演变。关键发现包括：股四头肌腱自体移植物因其尺寸充足和供区并发症低而受到重视，带骨块类型可能增强旋转稳定性；3D导航与个体化形态测量提高了骨道精准度；胫骨后倾角、髁间窝形态和膝关节过伸被确认为关键解剖危险因素。VR康复、血流限制训练及个体化…
英文摘要
PURPOSE: To synthesize recent developments in anterior cruciate ligament reconstruction (ACLR), highlighting emerging evidence, evolving surgical strategies, and persistent controversies in risk stratification, graft selection, surgical planning and rehabilitation. METHODS: A narrative review of the recent literature (2023-2026) was conducted, incorporating randomized controlled trials, systematic reviews, large registry analyses and emerging studies. The review focused on evolving concepts in graft selection, imaging-guided surgical planning, biomechanical risk factors, neuromuscular recovery and long-term outcomes following ACL reconstruction. RESULTS: Quadriceps tendon autografts have gained prominence for their robust dimensions and low donor-site morbidity, with bone-block variants potentially enhancing rotational stability. Imaging innovations-3D mapping, navigation and individualized morphometrics-improve tunnel precision. New studies reinforce posterior tibial slope, notch shape and hyperextension as critical anatomical risk factors. Neuromuscular training techniques such as VR-based rehabilitation, blood flow restriction, and individualized strength timelines improve functional symmetry and readiness. Registry data show rising ACLR rates, especially among young females, and link failure to younger age, high activity, delayed surgery and septic arthritis. PROMs correlate poorly with objective performance, underscoring the need for integrated assessment. Long-term outcomes remain favourable across graft types, with no consistent differences in osteoarthritis progression. CONCLUSION: ACLR is transitioning toward a precision-based, individualized model. This paradigm shift integrates anatomical risk profiling, tailored graft selection, and multimodal rehabilitation to optimize both biological and functional outcomes. Yet, unresolved questions, around pediatric predictors, repair techniques, and real-world adherence, highlight the need for ongoing refinement. The field is evolving from reconstruction toward comprehensive restoration, grounded in anatomy, technology and behavioural science. LEVEL OF EVIDENCE: Level V, narrative review.