前交叉韧带损伤膝关节的胫骨前移增加与撕裂位置无关且与早期至中期损伤慢性化独立相关
简介
521例初次ACL手术患者的回顾性研究显示，术前Lachmeter测量的前向胫骨移位侧间差（ATT-SSD）在各撕裂类型中均超过3 mm临床阈值；撕裂位置与损伤慢性化在单因素分析中均与ATT-SSD相关，但多因素回归后仅慢性化是独立影响因素。提示ACL撕裂位置本身不宜作为术前膝关节前向稳定性的预测指标。
英文摘要
PURPOSE: To determine whether anterior cruciate ligament (ACL) tear type and injury chronicity influence preoperative instrumented anterior tibial translation side-to-side difference (ATT-SSD) in patients undergoing primary ACL surgery, and, as a secondary aim, to evaluate the association between concomitant meniscal tears and ATT-SSD. METHODS: This retrospective single-surgeon study included 521 patients who underwent surgery for ACL injury between October 2019 and January 2026. Preoperative ATT-SSD was measured using a Lachmeter® digital arthrometer, and ACL tears were classified arthroscopically according to the modified Sherman classification. Injuries were categorized by time to first visit as acute (<28 days), subacute (28-90 days) or chronic (>90 days). Associations between tear type, chronicity, meniscal repair and ATT-SSD were assessed using analysis of variance, subgroup comparisons, interaction analysis and multivariable linear regression. RESULTS: ATT-SSD differed across tear-type groups (p = 0.006), with Types III-V tears demonstrating a 0.5-mm greater mean ATT-SSD than Type I tears (p = 0.004), while Type II tears did not differ significantly from either group. Acute injuries showed greater ATT-SSD than subacute and chronic injuries (4.6 ± 1.5 vs. 4.2 ± 1.5 and 4.0 ± 1.5 mm; p = 0.005). The tear type × chronicity interaction was not significant (B = 0.019, p = 0.951). ATT-SSD was higher in patients undergoing medial meniscus repair. In multivariable regression, only chronicity remained independently associated with ATT-SSD (B = -0.205, p = 0.032), whereas ACL tear location was not independently associated with ATT-SSD. CONCLUSIONS: Mean ATT-SSD remained above the clinically meaningful threshold of ≥3 mm across all ACL tear types. Although small differences in ATT-SSD were observed according to tear location and early-to-intermediate injury chronicity in unadjusted analyses, only chronicity remained independently associated with ATT-SSD after adjustment. These findings suggest that ACL tear location alone should not be seen as a clinical predictor of anterior sagittal knee stability after ACL injury. LEVEL OF EVIDENCE: Level III, retrospective cohort study.