在接受初次前交叉韧带重建术的患者中，接触性损伤机制与更高的前交叉韧带损伤严重程度量表严重程度独立相关
简介
这项回顾性分析纳入2022年11月至2024年11月连续482例运动相关原发性ACL完全断裂后行初次重建的患者，其中175例（36.3%）为接触损伤、307例（63.7%）为非接触损伤。接触损伤者的ACLISS平均分高于非接触损伤者（4.6 vs. 3.8），且更高严重度分级更常见；调整年龄、性别、BMI和伤后手术间隔后，接触损伤机制仍与更高严重度独立相关（…
英文摘要
PURPOSE: To determine whether injury mechanism and sport category were independently associated with overall structural injury severity after sport-related primary anterior cruciate ligament (ACL) rupture, as quantified by the Anterior Cruciate Ligament Injury Severity Scale (ACLISS). METHODS: This retrospective analysis of prospectively collected data included consecutive patients undergoing primary ACL reconstruction between November 2022 and November 2024. Eligible patients had sustained a complete primary ACL rupture during sport, undergone magnetic resonance imaging within 8 weeks of injury and had complete imaging and arthroscopic documentation. Injury mechanism was classified as contact or non-contact, and sports as pivoting-contact, pivoting-non-contact or non-pivoting. Associations with severity grade were assessed using proportional-odds ordinal logistic regression adjusted for age, sex, body mass index and injury-to-surgery interval. Models evaluated injury mechanism, sport category and both exposures simultaneously. The continuous score was examined in sensitivity analyses. RESULTS: Among 482 patients, 175 (36.3%) sustained contact injuries and 307 (63.7%) sustained non-contact injuries. Contact injuries had higher ACLISS mean scores than non-contact injuries (4.6 vs. 3.8; p < 0.001) and were more frequently classified in higher severity grades. In the fully adjusted model, contact injury remained independently associated with greater severity (odds ratio, 2.68; 95% confidence interval [CI], 1.68-4.27; p < 0.001), whereas sport category was no longer associated with severity. Adding injury mechanism improved model fit, whereas adding sport category to a model already containing injury mechanism did not. Continuous-score analysis confirmed the principal finding (adjusted mean difference, 0.60 points; 95% CI, 0.29-0.91; p < 0.001). CONCLUSION: Among patients undergoing primary ACL reconstruction after a sport-related ACL rupture, contact injury mechanism was independently associated with greater structural injury severity. This association persisted after adjustment for sport category, whereas the association with sport category was attenuated. Injury mechanism should therefore be documented when characterizing injury severity. LEVEL OF EVIDENCE: Level III.