胫骨后倾角与外侧关节外肌腱固定术在高危前交叉韧带重建中移植物存活率的相关性
简介
本研究回顾性分析了585例使用腘绳肌腱自体移植物行初次ACL重建的患者（随访≥6年），根据临床风险标准非随机分为低风险组（单纯ACLR）和高风险组（ACLR+LET），旨在评估胫骨后倾角（PTS）对移植物存活的影响以及LET在不同PTS下的保护作用。结果显示，PTS是两组移植物再撕裂的独立预测因素，且在高风险组中影响更强（校正比值比1.63 vs. 1.21…
英文摘要
BACKGROUND: Posterior tibial slope (PTS) is a well-established anatomic risk factor for anterior cruciate ligament (ACL) graft failure. Lateral extra-articular tenodesis (LET) is increasingly used as an adjunctive procedure in high-risk patients to reduce rerupture rates; however, how its protective effect varies across the continuum of slope values remains insufficiently characterized. PURPOSE: To determine how PTS modifies the protective effect of LET in high-risk patients and to evaluate the influence of PTS on graft failure across different risk profiles. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A retrospective cohort of 585 patients who underwent primary ACL reconstruction (ACLR) with hamstring tendon autografts between 2014 and 2017 was analyzed at a minimum follow-up of 6 years. Patients were nonrandomly allocated according to predefined clinical risk criteria into a low-risk group (isolated ACLR) and a high-risk group (ACLR + LET). A graft rerupture was defined clinically and confirmed by imaging. Multivariable logistic regression was used to assess the association between PTS and graft failure. Restricted cubic spline regression was also used to explore nonlinear relationships and identify slope ranges associated with low and high failure probabilities. RESULTS: PTS independently predicted a graft rerupture in both groups, with a stronger effect in the high-risk group (adjusted odds ratio, 1.63; P = .005) compared with the low-risk group (adjusted odds ratio, 1.21; P = .029). The relationship between PTS and graft failure was nonlinear. In the high-risk group, the lowest failure probabilities were observed within a PTS range of 5° to 9°, below which the risk of failure plateaued. In contrast, PTS values exceeding 11° to 12° were associated with high failure probabilities in both groups. CONCLUSION: PTS was independently associated with graft failure in both groups. Although LET was associated with lower failure probabilities within a moderate slope range, increasing PTS values were linked to a progressively higher risk of reruptures in both groups. The association between a steeper slope and failure observed in the ACLR with LET group suggests that an elevated PTS may attenuate the relative protective effect of LET.