解剖性前交叉韧带重建术后静态胫骨前移的纵向变化及预后因素
简介
该研究纳入95例前交叉韧带（ACL）解剖重建患者，通过负重位侧位X线片评估术后6、12、24个月静态胫骨前移（ATT）的纵向变化。结果显示，术后ATT较术前显著改善并保持稳定，但女性及较大的外侧胫骨后倾角是术后ATT改善不足的独立预后因素，且术后24个月时较大的ATT与残留轴移试验阳性显著相关。提示临床应关注此类高危患者，以优化术后康复和预后评估。
英文摘要
BACKGROUND: Anterior tibial translation (ATT) is a reported risk factor for residual pivot shift after anterior cruciate ligament (ACL) reconstruction. However, longitudinal postoperative changes in ATT are not well defined. This study aimed to evaluate the longitudinal changes in postoperative static ATT assessed under weightbearing conditions and to identify prognostic factors associated with residual static ATT. PURPOSE: To evaluate the longitudinal changes in postoperative static ATT assessed under weightbearing conditions and to identify prognostic factors associated with residual static ATT. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients who underwent primary anatomic ACL reconstruction between 2017 and 2023 with a minimum follow-up of 24 months were included. Static ATT was measured using lateral weightbearing radiographs preoperatively and at 6, 12, and 24 months postoperatively. A linear mixed-effects model estimated marginal predicted changes in static ATT over time, and additional mixed-effects models identified prognostic factors associated with postoperative static ATT. The association between postoperative static ATT at 24 months and residual postoperative pivot shift was analyzed. RESULTS: In total, 95 patients were included. Static ATT significantly decreased at 6 months compared with preoperative values (P < .01) and remained stable at 12 and 24 months, with no significant differences among the postoperative time points. The predicted change in static ATT from preoperative to 24 months was -1.32 mm (95% CI, -1.93 to -0.70; P < .01). Multivariate linear mixed-effects regression analysis revealed that female sex (estimate, 1.45 mm; P = .03) and a greater lateral posterior tibial slope (estimate, 0.28 mm per degree; P = .01) were independently associated with increased postoperative static ATT. At 24 months, greater static ATT was associated with residual pivot shift (odds ratio, 1.45; 95% CI, 1.10-1.92; P = .01). CONCLUSION: Static ATT improved after ACL reconstruction and remained stable through 24 months. Female sex and a steeper lateral PTS were independently associated with less postoperative improvement in static ATT. Greater postoperative static ATT was also associated with residual pivot shift.