德尔菲专家共识确定翻修手术、高度轴移和高风险旋转运动运动员是前交叉韧带重建中行前外侧韧带重建或外侧关节外手术的适应证
简介
Delphi专家共识纳入40位专家，经三轮投票明确：高度轴移、ACL翻修及高风险旋转运动人群是ACLR联合ALLR/LEAP的适应证，关节松弛和年轻患者为相对适应证，不推荐所有ACL患者常规加做。LEAP通过抵抗胫骨内旋减少移植物张力，但可能过度约束，股骨固定点应置于外上髁后上方。证据级别V级。
英文摘要
PURPOSE: To conduct a Delphi expert consensus on the biomechanics, indications and contraindications, surgical techniques, and complications associated with augmenting anterior cruciate ligament (ACL) reconstruction (ACLR) with either anterolateral ligament reconstruction (ALLR) or lateral extra-articular procedure (LEAP). METHODS: Forty panel members were included. In Round 1, the panel addressed 18 open-ended questions on ALLR or LEAP in ACL surgery, followed by 8 semi-open-ended questions in Round 2. They assessed 27 potential indications for ALLR/LEAP, ranking their relevance and importance. In Round 3, 73 items on biomechanics, surgical techniques, contraindications, and complications were presented for final voting. RESULTS: Unanimous consensus supports LEAP or ALLR for high-grade pivot shifts and revision ACL surgery. Very strong consensus confirms LEAP resists internal tibial rotation, reduces ACL stress with ACLR, and requires femoral fixation posterior and proximal to the lateral epicondyle. Strong consensus supports additional surgery for hyperlaxity and high-risk athletes in pivoting sports. Consensus highlights risks of overconstraint, altered knee mechanics, and technical challenges. Young athletes are suitable candidates. Disagreement remains on routine LEAP/ALLR for all ACL patients, regardless of activity or compliance. CONCLUSIONS: This Delphi Expert Consensus has established that high-grade pivot shift, revision surgery, and participation in high-risk athletes in pivoting sports are indications for anterolateral augmentation procedures in ACLR. Generalized joint hyperlaxity and young age were identified as relative indications. The routine use of LEAP or ALLR in all ACL-deficient or low-demand patients is not recommended. LEAP primarily functions to resist internal tibial rotation and can reduce graft strain when performed in conjunction with ACLR. However, LEAP may overconstrain internal knee rotation and is considered a nonanatomic approach to rotational stability. For optimal biomechanical function, the femoral tunnel or fixation point for LEAP should be placed posterior and proximal to the lateral femoral epicondyle. LEVEL OF EVIDENCE: Level V, expert opinion.