年龄较小、膝关节过伸、同时进行半月板切除术以及手术前胫骨前移较大与前交叉韧带翻修重建术后移植物失败有关

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-09-25 DOI:10.1002/jeo2.70021

Takeo Tokura, Takehiko Matsushita, Kyohei Nishida, Kanto Nagai, Noriyuki Kanzaki, Yuichi Hoshino, Tomoyuki Matsumoto, Ryosuke Kuroda

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引用次数: 0

摘要

目的前交叉韧带（ACL）翻修重建术后的移植物失败率高于初次前交叉韧带重建术。然而，有关翻修手术的数据却很少。我们旨在评估前交叉韧带翻修重建失败的相关因素。方法对在我院接受前交叉韧带翻修重建术且随访时间≥1年的54例患者（平均年龄：24.7 ± 10.0岁）进行回顾性研究。患者被分为 F 组（移植物失败）和 N 组（无移植物失败）。进行单变量分析以确定与移植物失败相关的因素。进行受体操作特征曲线（ROC）分析，以确定区分两组的最佳阈值。结果 54 例患者中有 7 例（13.0%）出现移植物失败。在单变量分析中，首次手术时的年龄（F 组：15.6 ± 1.5，N 组：20.9 ± 8.1）、翻修手术时的年龄（F 组：18.0 ± 2.8，N 组：25.7 ± 10.3）、膝关节是否过度伸展（F 组：85.7%，N组：14.9%）、同时进行半月板切除术（F组：42.9%，N组：14.9%）、前交叉韧带（sACL）切前间隙（F组：7.2 ± 3.4 mm，N组：13.4 ± 4.7 mm）和术前胫骨前移（ATT）（F组：5.0 ± 1.4 mm，N组：2.7 ± 3.1 m）。对单腿站立平片上的术前 sACL 和术前 ATT 进行的 ROC 分析表明，6.9 毫米和 4.2 毫米的临界值分别是最佳临界值。结论前交叉韧带翻修重建术前，膝关节过伸、同时进行半月板切除术、sACL 较小且 ATT 较大的年轻患者容易发生移植失败。证据等级 IV 级。

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Younger age, hyperextended knee, concomitant meniscectomy and large prerevision anterior tibial translation are associated with graft failure after the revision anterior cruciate ligament reconstruction

Purpose

Graft failure following revision anterior cruciate ligament (ACL) reconstruction is higher than after primary ACL reconstruction. However, data regarding revision surgery is scarce. We aimed to evaluate the associated factors for failure after revision ACL reconstruction.

Methods

Fifty-four patients (mean age: 24.7 ± 10.0 years) who underwent revision ACL reconstruction at our hospital with ≥1 year follow-up were retrospectively examined. Patients were divided into Group F (graft failure) and Group N (no graft failure) groups. Univariate analysis was conducted to identify factors associated with graft failure. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal thresholds for differentiating between the two groups.

Results

Graft failure was observed in 7 of 54 patients (13.0%). In the univariate analysis, significant differences were observed for age at the initial surgery (Group F: 15.6 ± 1.5, Group N: 20.9 ± 8.1), age at the revision surgery (Group F: 18.0 ± 2.8, Group N: 25.7 ± 10.3), presence of hyperextended knee (Group F: 85.7%, Group N: 14.9%), concomitant meniscectomy (Group F: 42.9%, Group N: 14.9%), prerevision space for the ACL (sACL) (Group F: 7.2 ± 3.4 mm, Group N: 13.4 ± 4.7 mm) and preoperative anterior tibial translation (ATT) (Group F: 5.0 ± 1.4 mm, Group N: 2.7 ± 3.1 m). ROC analysis of preoperative sACL and preoperative ATT on one-leg standing plain radiograph showed that cutoff values of 6.9 and 4.2 mm were the optimal thresholds, respectively.

Conclusion

Younger patients with a hyperextended knee, concomitant meniscectomy, small sACL and large ATT before revision ACL reconstruction are predisposed to graft failure.