成人前交叉韧带翻修术的当前治疗理念
简介
这篇综述聚焦于成人前交叉韧带翻修术（ACLRev）的当前理念，指出该手术复杂且挑战性高，尤其适用于高功能需求的年轻不稳患者。文章基于欧洲共识，重点讨论了移植物选择（优先自体移植物）、一期或二期手术决策、以及合并损伤（如ramp lesion、根部撕裂、内外侧不稳或力线异常）的处理策略，并强调前外侧结构加强术可降低失败率，而胫骨后倾角矫正截骨术的作用尚待明确。
英文摘要
Anterior cruciate ligament revision (ACLRev) remains a complex and demanding procedure. Although an increasing number of studies identified factors associated with graft failure and revision outcomes, clear and practical guidelines are still limited. To address these gaps, the European Society for Sports Traumatology, Knee Surgery and Arthroscopy developed a consensus aimed at standardizing indications for ACLRev. Although this initiative provided important guidance, some questions remain unresolved, such as the optimal graft choice and the management of associated procedures. The aim of this review is to provide an updated overview of current literature regarding preoperative planning, surgical techniques and ACLRev management. ACLRev is currently indicated after previous anterior cruciate ligament reconstruction resulting in knee instability, particularly in younger patients with high-functional demands. ACLRev may be performed as a one- or two-stage procedure. A two-stage approach is appropriate in case of infection, arthrofibrosis or insufficient bone stock that precludes secure and anatomical graft fixation. Autografts are generally preferred, particularly in young active patients, due to lower reported failure rates. Increasing attention has been directed to treatment of associated pathologies, such as ramp and root lesions, associated ligamentous instabilities (medial and lateral) or bony malalignment. Additional extraarticular anterolateral procedures are frequently used to reduce failure rates and improve rotational stability. Conversely, the role of slope-reducing osteotomies in ACLRev remains less defined, with good outcomes reported in small case series. Despite the growing body of clinical research, several issues remain unresolved, including the optimal individualized graft selection and indications for combined procedures. This manuscript summarizes the most recent evidence on ACLRev management, with emphasis on graft selection, indications for extraarticular anterolateral procedures, management of medial instability and principles of slope correction. Future high-level studies are needed, particularly addressing peripheral soft-tissue management and osseous corrections, to establish guidelines and enhance clinical outcomes for patients undergoing ACLRev. LEVEL OF EVIDENCE: Level V, expert opinion.