术前动态胫骨前移不能预测前交叉韧带重建术后移植物断裂
简介
该研究纳入680例接受腘绳肌腱自体移植物ACL重建的患者，随访至少6年，旨在评估术前动态胫骨前移（DATT）是否为移植物破裂的风险因素。结果显示，41例（6%）发生移植物破裂，平均发生在术后45±30个月。患侧DATT中位数为9 mm，ΔDATT（双侧差值）中位数为6 mm。ΔDATT≥6 mm组与<6 mm组的移植物破裂率无显著差异（6.3% vs. 5.…
英文摘要
PURPOSE: This study aimed to determine whether higher preoperative dynamic anterior tibial translation (DATT) using laximetry is a risk factor for graft rupture after anterior cruciate ligament reconstruction (ACLR). METHODS: This retrospective study included all patients who underwent primary ACLR with hamstring autograft between January 2014 and December 2017. Demographic data, absolute DATT on the injured side and ΔDATT (side-to-side difference), posterior tibial slope (PTS), static anterior tibial translation (SATT), concomitant lateral extra-articular tenodesis (LET) and meniscal tears were collected. Subgroup analysis was performed using a ΔDATT threshold of 6 mm. Univariate and multivariable logistic regression analyses were conducted to identify independent risk factors for ACL graft rupture. RESULTS: Among the 680 patients included with a minimum follow-up of 6 years, 41 (6%) experienced graft rupture at a mean of 45 ± 30 months postoperatively. The median DATT on the injured side was 9 mm [interquartile range, IQR, 5], and the median ΔDATT was 6 mm [IQR, 4]. Graft rupture occurred in 5.8% for patients with ΔDATT < 6 mm and in 6.3% for patients with ΔDATT ≥ 6 mm (p = 0.787). Patients with ΔDATT ≥ 6 mm demonstrated a higher prevalence of medial meniscal tears (31% vs. 24%, p = 0.026). Independent risk factors for graft rupture included PTS ≥ 12° (odds ratio [OR] 3.1; 95% confidence interval [CI], 1.6-6.3; p < 0.001) and SATT ≥ 5 mm (OR 2.6; 95% CI, 1.2-5.5; p = 0.027), whereas neither ΔDATT nor absolute DATT was significantly associated with graft rupture. CONCLUSION: Preoperative DATT is not predictive of graft rupture following ACLR using hamstring autograft. PTS and SATT remain stronger predictors and should be prioritised for preoperative risk stratification. LEVEL OF EVIDENCE: Level III, retrospective case-control study.