糖尿病对前交叉韧带重建术后翻修风险的影响：一项真实世界数据研究
简介
一项基于TriNetX全球联邦健康研究网络的回顾性观察队列纳入73,951例初次前交叉韧带重建（ACLR）患者，其中糖尿病990例（1.3%）；按年龄、性别和BMI 1:1倾向评分匹配后各988例，5年内翻修ACLR分别为30例和38例，未观察到翻修风险显著差异（HR 0.77，95% CI 0.47–1.26）。排除合并半月板切除/修复、半月板移植及其他韧…
英文摘要
INTRODUCTION: Given the increasing prevalence of diabetes mellitus (DM), understanding its impact on anterior cruciate ligament reconstruction (ACLR) revision risk is important for clinical decision-making and patient counselling. This study evaluated whether DM is associated with an increased risk of revision ACLR within 5 years of primary reconstruction. METHODS: We conducted a retrospective observational cohort study using a global federated health research network (TriNetX, Cambridge, USA), including 73,951 patients who underwent primary ACLR across 53 healthcare organisations, of whom 990 had DM (type 1 and 2). Patients undergoing primary ACLR between 5 August 2005 and 4 August 2025 were included. The index event was primary ACLR, and the outcome was subsequent ACLR to the ipsilateral knee. Follow-up was extended until revision surgery or up to 5 years. Patients with DM (type 1 or type 2) were compared with patients without DM following 1:1 propensity score matching for age, sex, and BMI. Following propensity score matching, 988 patients were analysed per cohort. Kaplan-Meier survival analysis and hazard ratios (HRs) were used to assess revision risk. A further sensitivity analysis excluded patients undergoing concomitant soft tissue knee procedures, including meniscectomy, meniscal repair, meniscal transplantation, and additional ligament reconstruction procedures. RESULTS: Of the 73,951 patients included, 990 had DM, corresponding to a prevalence of 1.3% among individuals undergoing ACLR. Following propensity score matching, revision ACLR occurred in 30 of 988 patients with DM and 38 of 988 patients without DM, with no statistically significant difference in revision risk between the cohorts (HR 0.77, 95% CI 0.47-1.26). In the sensitivity analysis excluding patients with concomitant soft tissue knee procedures, between 1 and 10 revision events occurred in each matched cohort (243 patients per cohort), and no statistically significant difference in revision risk was observed (HR 0.45, 95% CI 0.08-2.45). CONCLUSION: DM was not associated with an increased risk of revision ACLR within 5 years of the primary procedure. These findings were consistent in a sensitivity analysis excluding concomitant soft tissue knee procedures. The results should be interpreted in the context of the study's limitations and do not replace individualised clinical risk assessment.