前交叉韧带移植物失效：失效分析、危险因素及手术策略的最新进展
简介
这篇综述系统分析了前交叉韧带（ACL）移植物失败的原因，强调翻修术前需通过全长X线片、CT及MRI全面评估骨道位置、胫骨后倾角及下肢力线。失败因素常为多因素，包括技术性（骨道位置不良）、生物性（移植物愈合不良）及生物力学性（胫骨后倾角增大、冠状面力线异常）。临床处理需个体化，必要时联合胫骨截骨、内外翻截骨或外侧关节外肌腱固定术，以纠正可调控的危险因素。
英文摘要
Revision reconstruction of the anterior cruciate ligament (ACL) presents a considerable challenge - due to its technical complexity, variable clinical presentations, and the interplay of multiple risk factors and concomitant pathologies. Optimal treatment requires a thorough analysis of the causes of failure. The preoperative evaluation should include full-leg radiographs, lateral X-rays of the entire lower leg, magnetic resonance imaging (MRI) to assess soft tissue pathologies, and computed tomography (CT) to evaluate tunnel position and tunnel widening. Graft failure is usually multifactorial and may be related to technical, biological, demographic, or biomechanical causes. Technical issues include malpositioning of the tunnels, unaddressed primary instabilities, fixation failure, or inadequate graft tensioning. Biological factors comprise impaired graft incorporation and infections. Biomechanical and anatomical factors-such as increased posterior tibial slope (PTS), coronal plane malalignment, or persistent peripheral or rotational instabilities-must also be recognised and addressed. For this purpose, additional surgical techniques are available - such as slope-reducing osteotomy, varus and valgus osteotomies, as well as lateral extra-articular tenodesis. A successful revision ACL reconstruction is based on a comprehensive analysis of the underlying causes, individually tailored surgical strategies, correction of modifiable predisposing factors, and realistic patient counseling. These measures are crucial for achieving good functional outcomes and long-term stability, while enabling a safe return to the desired level of activity without recurrent injury.