对侧ACL断裂作为ACL重建术后移植物失效内在风险的指标：来自SANTI研究组的7718例患者队列研究
简介
一项来自SANTI研究组的队列研究纳入7718例初次ACL重建患者，旨在明确双侧原生ACL断裂史是否增加移植物失败风险。结果显示，双侧断裂组移植物失败率为9.3%，显著高于单侧组的5.2%（P<0.0001）。多因素回归分析确认双侧断裂是独立危险因素（OR=1.34），其他独立预测因素包括年轻、男性、高Tegner评分。临床意义：对侧ACL断裂可作为患者内在…
英文摘要
BACKGROUND: Graft failure after anterior cruciate ligament (ACL) reconstruction (ACLR) may be influenced by both extrinsic exposure and intrinsic patient susceptibility. A contralateral ACL rupture could reflect an inherent predisposition to ligament injury. PURPOSE: To determine whether a history of bilateral native ACL ruptures increases the risk of graft failure after primary ACLR. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 7718 consecutive patients who underwent primary ACLR by a single surgeon (2003-2022) were included. Graft failure, defined as a clinically and magnetic resonance imaging-confirmed rupture, was compared between patients with bilateral versus unilateral native ACL ruptures. Multivariable logistic regression identified independent predictors, including age, sex, Tegner score, sport type, and a history of bilateral rupture. RESULTS: The cohort included 6327 patients with isolated native ACL rupture and 1391 patients with bilateral native ACL rupture. The overall graft failure rate was 6% (461-7718), with a mean follow-up of 135.9 months. Patients with bilateral ACL ruptures had a higher failure rate (9.3%) than those with unilateral injuries (5.2%) (P < .0001). Independent predictors included younger age (odds ratio [OR], 0.92 [95% CI, 0.90-0.93]; P < .0001), male sex (OR, 1.46 [95% CI, 1.10-1.96]; P = .0089), higher Tegner score (OR, 1.09 [95% CI, 1-1.19]; P = .043), and bilateral rupture (OR, 1.34 [95% CI, 1.03-1.73]; P = .028). CONCLUSION: Bilateral native ACL rupture independently increases the risk of graft failure after ACLR. This finding supports its use as a marker of intrinsic vulnerability that may warrant targeted preventive or surgical strategies.