胫骨外翻联合截骨术和前交叉韧带重建术可改善膝关节功能和稳定性：系统综述》。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2024-08-01 DOI:10.1016/j.jisako.2024.06.010

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引用次数: 0

摘要

重要性：胫骨后斜度（PTS）过大的患者前交叉韧带（ACL）重建（ACL-R）失败的风险较高，而ACL-R翻修手术后的临床效果通常较差：对文献进行系统性回顾，总结在PTS过高的情况下，使用胫骨外翻截骨术结合ACL-R手术治疗前交叉韧带功能不全的临床和放射学结果：我们使用 PubMed、Cochrane Library 和 OVID Medline 数据库对 1990 年至今的文献进行了系统性回顾。纳入标准为：关于孤立胫骨外翻截骨术与初治或复治 ACL-R 手术效果的英文研究。所提取的数据包括研究者的人口统计学信息、胫骨外翻截骨术的类型和伴随手术、放射学结果、患者报告结果评分以及术后并发症发现：共确定了六项研究，涉及 133 个膝关节。所有纳入的研究均为回顾性病例系列，加权平均随访时间为 3.39 年。133个膝关节中有106个（79.7%）在进行前交叉韧带重建术的同时进行了胫骨外翻截骨术，133个膝关节中有27个（20.3%）进行了分期手术。133个膝关节中分别有22个、45个和66个（16.5%、33.8%和49.6%）接受了初次、第一次翻修和第二次或更多次翻修前交叉韧带重建术。133 个膝关节中有 3 个（2.25%）在最终随访时显示前交叉韧带移植失败。平均而言，PTS 从术前的 15.2 度降至术后的 7.1 度。国际膝关节文献委员会（IKDC）、Lysholm和Tegner的平均评分从术前的42.5分、46.4分和4.2分上升到术后的71.8分、89.0分和6.7分：本综述结果表明，联合 ACL-R 和胫骨外翻截骨术可有效降低 PTS，改善膝关节功能和稳定性：研究设计：系统综述；证据等级4。

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Combined tibial deflexion osteotomy and anterior cruciate ligament reconstruction improves knee function and stability: A systematic review

Importance

Patients with excessive posterior tibial slope (PTS) may have higher risks of anterior cruciate ligament (ACL) reconstruction (ACL-R) failure, and clinical outcomes after revision of ACL-R procedures are typically poor.

Objective

This study aimed to perform a systematic review of the literature summarizing the clinical and radiological outcomes of the surgical treatment of ACL insufficiency in the setting of excessive PTS using a tibial deflexion osteotomy combined with ACL-R.

Evidence review

A systematic review of the literature was performed using PubMed, Cochrane Library, and OVID Medline databases from 1990 to present. Inclusion criteria were studies of outcomes of isolated tibial deflexion osteotomies performed with primary or revision ACL-R in the English language. Data extracted included study demographic information, type of tibial deflexion osteotomy and concomitant procedures, radiological outcomes, patient-reported outcome scores, and postoperative complications.

Findings

Six studies, with 133 knees were identified. All included studies were retrospective case series, with a weighted mean follow-up of 3.39 years. In 106 of 133 (79.7%) knees, tibial deflexion osteotomy was performed concomitantly with an ACL-R, whereas in 27 of 133 (20.3%) knees, the procedures were staged. 22, 45, and 66 of 133 knees (16.5%, 33.8%, and 49.6%) underwent primary, first revision, and second or greater revision ACL-R, respectively. Three of 133 (2.25%) knees demonstrated recurrent ACL graft failure at the final follow-up. On average, PTS decreased from 15.2° preoperatively to 7.1° postoperatively. The mean International Knee Documentation Committee, Lysholm, and Tegner scores increased from 42.5, 46.4, and 4.2 preoperatively to 71.8, 89.0, and 6.7 postoperatively.

Conclusions

The results of this review suggest that combined ACL-R and tibial deflexion osteotomy may be effective in decreasing PTS and improving knee function and stability.