Preoperative knee laxity is not associated with subjective knee function or revision surgery after primary anterior cruciate ligament reconstruction: An analysis of 5425 patients

IF 5.5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2026-07-29 Epub Date: 2025-09-04 DOI:10.1002/ksa.70058

Riccardo Cristiani, Christoffer von Essen, Eric Hamrin Senorski, Camilo P. Helito, Kristian Samuelsson, Karl Eriksson, Magnus Forssblad, Anders Stålman

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引用次数: 0

Abstract

Purpose

To determine whether preoperative knee laxity, as measured by the KT-1000 arthrometer, was associated with subjective knee function preoperatively and at 1, 2 and 5 years, or with revision anterior cruciate ligament (ACL) reconstruction (ACLR) within 5 years of the primary surgery.

Methods

Patients who underwent primary ACLR using a hamstring tendon autograft at the Capio Artro Clinic, Stockholm, Sweden, between January 1, 2005, and December 31, 2018, and had no associated ligament injuries, were identified. The KT-1000 arthrometer (134-N) was used to assess knee laxity preoperatively. The Knee injury and Osteoarthritis Outcome Score (KOOS) was obtained preoperatively and at 1-, 2- and 5-year follow-ups. Patients who underwent revision ACLR at any hospital or clinic nationwide within 5 years of their primary surgery were identified via the Swedish Knee Ligament Registry. KOOS subscale scores between groups were compared using analysis of covariance (ANCOVA), while differences in revision ACLR rates were evaluated using Cox regression analysis.

Results

A total of 5425 patients (54.0% male) with available preoperative KT-1000 arthrometer measurements were included: side-to-side (STS) ≤ 2 mm, 1833 (33.8%); STS 3–5 mm, 2387 (44.0%); STS > 5 mm, 1205 (22.2%). The only significant differences in subjective knee function among the groups were observed in the preoperative KOOS Symptoms (STS ≤ 2 mm: 75.0 ± 17.4; STS 3–5 mm: 75.1 ± 17.5; STS > 5 mm: 76.4 ± 17.1; P = 0.03) and Pain (STS ≤ 2 mm: 78.9 ± 15.9; STS 3–5 mm: 79.4 ± 15.9; STS > 5 mm: 80.4 ± 15.2; p = 0.02) subscale. No additional significant differences were observed between the groups in any of the KOOS subscales at the preoperative assessment or at the 1-, 2- or 5-year postoperative follow-ups. At 5 years postoperatively, the revision ACLR rates were 4.8% (89/1833) in the STS ≤ 2 mm group, 4.9% (118/2387) in the STS 3–5 mm group and 6.0% (73/1205) in the STS > 5 mm group. The hazard of revision ACLR within 5 years did not differ significantly from the reference group (STS ≤ 2 mm) for either the STS 3–5 mm group (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.69–1.35; p = n.s.) or the STS > 5 mm group (HR, 1.19; 95% CI, 0.89–1.60; P = n.s.). The incidence of medial meniscus injury increased progressively across the laxity groups from 20.7% in the STS ≤ 2 mm group, to 25.0% in the STS 3-5 mm group and 31.9% in the STS > 5 mm group.

Conclusions

The degree of preoperative knee laxity, as measured by the KT-1000 arthrometer, was not associated with postoperative subjective knee function or revision ACLR within 5 years of primary surgery. Medial meniscus injuries were associated with greater preoperative knee laxity. The findings of this study suggest that preoperative arthrometric knee laxity should not be considered as a prognostic factor for ACLR outcomes.

Level of Evidence

Level III.

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术前膝关节松弛与原发性前交叉韧带重建后的主观膝关节功能或翻修手术无关：一项对5425例患者的分析。

目的：确定术前膝关节松弛度（由KT-1000关节计测量）是否与术前、1年、2年和5年的主观膝关节功能相关，或与初次手术后5年内的前交叉韧带（ACL）重建（ACLR）相关。方法：2005年1月1日至2018年12月31日期间，在瑞典斯德哥尔摩Capio Artro诊所接受腘绳肌腱自体移植的原发性ACLR患者，无相关韧带损伤。术前使用KT-1000关节计（134-N）评估膝关节松弛度。术前、1年、2年和5年随访时获得膝关节损伤和骨关节炎结局评分（oos）。首次手术5年内在全国任何医院或诊所接受改良ACLR的患者通过瑞典膝关节韧带登记处确定。采用协方差分析（ANCOVA）比较各组间kos分量表得分，采用Cox回归分析评估修订ACLR率的差异。结果：5425例患者（男性54.0%）术前可进行KT-1000关节计测量：侧对侧(STS)≤2 mm， 1833例（33.8%）；STS 3-5 mm, 2387 (44.0%)；STS > 5 mm, 1205（22.2%）。组间主观膝关节功能的唯一显著差异是术前KOOS症状（STS≤2mm: 75.0±17.4;STS 3-5 mm: 75.1±17.5;STS > 5mm: 76.4±17.1,P = 0.03）和疼痛（STS≤2mm: 78.9±15.9;STS 3-5 mm: 79.4±15.9;STS > 5mm: 80.4±15.2,P = 0.02）亚量表。在术前评估或术后1年、2年或5年随访时，两组之间的任何oos亚量表均未观察到其他显著差异。术后5年，STS≤2mm组矫正ACLR率为4.8% (89/1833)，STS 3-5 mm组为4.9% (118/2387)，STS bb0 -5 mm组为6.0%（73/1205）。无论是STS 3-5 mm组（风险比[HR]， 0.96； 95%可信区间[CI]， 0.69-1.35; P = 0.05）还是STS 5 -5 mm组（风险比，1.19;95% CI, 0.89-1.60; P = 0.05）， 5年内修正ACLR的风险与参照组（STS≤2 mm）均无显著差异。内侧半月板损伤的发生率在松弛组中逐渐增加，从STS≤2mm组的20.7%，到STS 3-5 mm组的25.0%和STS bbb5 mm组的31.9%。结论：由KT-1000关节计测量的术前膝关节松弛程度与初次手术后5年内的术后主观膝关节功能或翻修ACLR无关。内侧半月板损伤与术前膝关节松弛有关。本研究结果表明，术前关节测量膝关节松弛不应被视为ACLR预后的一个因素。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 Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).