内侧胫骨后倾角增大与ACL重建术后随时间推移胫骨前移增加相关
简介
319例初次ACL重建（腘绳肌腱自体移植物）的纵向队列显示，术后2年绝对前向胫骨平移增至6.8±4.0 mm，内侧胫骨后倾角与ATT侧-侧差值在1年（r=0.2）和2年（r=0.3）呈弱正相关，且为独立预测因素。年龄较大和内侧软骨损伤与术后松弛增加相关，而LET可减弱该效应（2年ATT侧-侧差值6.1 vs 7.3 mm）。提示内侧胫骨后倾角较大者宜考虑联合…
英文摘要
PURPOSE: To investigate the longitudinal relationship between medial posterior tibial slope (PTS) and postoperative anterior tibial translation (ATT) following anterior cruciate ligament reconstruction (ACLR), and to determine whether age, cartilage lesions and the use of lateral extra-articular tenodesis (LET) modify this relationship. METHODS: We retrospectively analysed 319 patients who underwent primary ACLR with a semitendinosus autograft. Medial PTS was measured on long lateral radiographs (circle method) at 2 months and at final follow-up. ATT was assessed by Telos™ stress radiography in both knees preoperatively and at 2 months, 1 year and 2 years. Three measures were defined: the absolute ATT of the operated knee; the ATT side-to-side difference (ATT SSD; operated minus contralateral knee); and the change in this difference from the preoperative baseline (ΔATT SSD). Associations were tested with Pearson's/Kendall's correlation, group comparisons and multivariable regression; subgroups were defined by age, cartilage status and LET. RESULTS: The absolute operated-knee ATT was 5.8 ± 3.5 mm preoperatively and 2.9 ± 2.3, 4.9 ± 2.8 and 6.8 ± 4.0 mm at 2 months, 1 year and 2 years, respectively. Medial PTS correlated positively but weakly with the ATT SSD at 1 year (r = 0.2, p = 0.001) and 2 years (r = 0.3, p < 0.001); at 2 months, the correlation was negative and non-significant (r = -0.5, p = 0.3). Medial PTS at 2 months and at final follow-up were independent predictors of the ATT SSD on multivariable regression (p < 0.01). Older age (r = 0.15, p = 0.009) and medial cartilage lesions (p = 0.008) were associated with greater postoperative laxity, whereas LET was associated with a lower 2-year ATT SSD (6.1 vs. 7.3 mm; p = 0.009). Meniscal and lateral cartilage lesions showed no significant association. CONCLUSION: Steeper medial PTS is associated with a progressive, though weak, increase in the ATT SSD following ACLR. LET attenuates this effect, whereas older age and medial cartilage lesions are associated with greater early laxity. LEVEL OF EVIDENCE: Level III.