Graft diameter does not affect re-rupture rates or clinical outcomes in double-bundle anterior cruciate ligament reconstruction

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee Pub Date : 2025-05-30 DOI:10.1016/j.knee.2025.05.022

K. Goto, H. Iwaso, E. Honda, S. Sameshima, M. Inagawa, Y. Ishida, K. Matsuo, R. Kuzuhara, T. Sanada

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引用次数: 0

Abstract

Background

While a graft diameter of less than 8 mm is considered a risk factor for re-rupture in single-bundle anterior cruciate ligament reconstruction (ACLR), no studies have investigated the threshold for risk in double-bundle ACLR (DB-ACLR). This study aimed to evaluate the relationship between graft diameter and re-rupture rates in DB-ACLR.

Methods

This study included 589 knees that underwent DB-ACLR with a minimum follow-up of 2 years. The total cross sectional area (CSA) of the grafts was calculated from the diameters of the anteromedial bundle (AMB) and posterolateral bundle (PLB). A restricted cubic spline regression model was applied to evaluate the relationship between total CSA and graft re-rupture. Although no statistically significant cutoff value was identified, the analysis suggested potential differences in re-rupture rates between knees with extremely small or large CSAs. Based on this finding, knees were classified into two groups: Group S (total CSA < 39 mm², corresponding to a single-bundle diameter < 7 mm) and Group L (total CSA > 50 mm², corresponding to a single-bundle diameter > 8 mm). Propensity score matching was conducted to adjust for confounding factors, including age, height, and weight, and re-rupture rates and Knee injury and Osteoarthritis Outcome Score (KOOS) were compared between the groups.

Results

Graft re-rupture was observed in 37 out of 589 knees (6.3%). The mean graft diameter was 5.3 ± 0.4 mm for AMB, 5.0 ± 0.4 mm for PLB, and 41.5 ± 7.1 mm² for total CSA. Restricted cubic spline regression analysis showed a slight decrease in the log odds of re-rupture with increasing CSA, but no significant cutoff value was identified, and the observed trend was not statistically significant. After propensity score matching, there were no significant differences in re-rupture rates (13.5% in Group S vs. 8.1% in Group L, p = 0.71) or KOOS scores between the groups.

Conclusion

In DB-ACLR, no clear cutoff value for graft diameter was identified, and total CSA was not a significant risk factor for re-rupture. Knees with small-diameter grafts demonstrated comparable re-rupture rates and KOOS scores to those with larger-diameter grafts.

Level of Evidence: Level III.

查看原文本刊更多论文

移植物直径对双束前交叉韧带重建的再破裂率和临床结果没有影响

虽然移植物直径小于8mm被认为是单束前交叉韧带重建（ACLR）中再次破裂的危险因素，但没有研究调查双束前交叉韧带重建（DB-ACLR）的风险阈值。本研究旨在评估DB-ACLR中移植物直径与再破裂率的关系。方法本研究纳入589例行DB-ACLR的膝关节，随访至少2年。根据前内侧束（AMB）和后外侧束（PLB）的直径计算移植物的总横截面积（CSA）。应用限制三次样条回归模型评价总CSA与接枝再破裂的关系。虽然没有统计学上显著的临界值被确定，但分析表明，极小或极大csa的膝关节在再破裂率上存在潜在差异。基于这一发现，将膝关节分为两组：S组(总CSA <；39 mm2，对应单束直径<；7mm)和L组(总CSA >；50mm2，对应单束直径>；8毫米)。进行倾向评分匹配以调整混杂因素，包括年龄、身高和体重，再破裂率和膝关节损伤和骨关节炎结局评分（oos）在组间进行比较。结果589例膝关节中37例（6.3%）发生移植物再破裂。AMB的平均移植物直径为5.3±0.4 mm， PLB为5.0±0.4 mm，总CSA为41.5±7.1 mm2。限制三次样条回归分析显示，随着CSA的增加，再破裂的对数概率略有下降，但没有发现显著的截断值，观察到的趋势无统计学意义。倾向评分匹配后，两组间再破裂率（S组为13.5%，L组为8.1%,p = 0.71）和kos评分无显著差异。结论在DB-ACLR中，移植物直径没有明确的临界值，总CSA不是再破裂的重要危险因素。与大直径移植物相比，小直径移植物的膝关节再次破裂率和KOOS评分相当。证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee 医学-外科

CiteScore

3.80

自引率

5.30%

发文量

171

审稿时长

6 months

期刊介绍： The Knee is an international journal publishing studies on the clinical treatment and fundamental biomechanical characteristics of this joint. The aim of the journal is to provide a vehicle relevant to surgeons, biomedical engineers, imaging specialists, materials scientists, rehabilitation personnel and all those with an interest in the knee. The topics covered include, but are not limited to: • Anatomy, physiology, morphology and biochemistry; • Biomechanical studies; • Advances in the development of prosthetic, orthotic and augmentation devices; • Imaging and diagnostic techniques; • Pathology; • Trauma; • Surgery; • Rehabilitation.