采用降斜度高位胫骨截骨翻修前交叉韧带重建术，临床效果满意，失败率低

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-05-19 DOI:10.1002/jeo2.70260

Lorenz Fritsch, Konstantin Dworschak, Maximilian Hinz, Philipp W. Winkler, Bastian Scheiderer, Sebastian Siebenlist, Romed Vieider, Lukas Willinger, Stefan Hinterwimmer, Julian Mehl

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引用次数: 0

摘要

目的：本研究旨在评估两阶段降低胫骨高位截骨（HTO）和翻修前交叉韧带重建术（ACLR）治疗复发性前交叉韧带功能不全并胫骨后倾角（PTS）增加[gt； 12°]的临床和影像学结果。方法选取2015年1月至2022年1月在两个中心手术的患者，在ACLR翻修后至少随访24个月。术后疼痛及以下评分：IKDC、kos、Lysholm、TAS。术后使用Dejour技术测量斜度，使用侧位x线片与术前x线片进行比较。此外，临床检查包括活动范围，前后平移和枢轴移位。Rolimeter用于胫骨前平移（ATT）。结果24例(18 m, 6 f；年龄：27±8岁，平均随访34±10个月。分降低15.2°±2.4°到5.7°±3.8°。最终随访评分：IKDC 75.5±1.5,Lysholm 79.9±12.7,kos 77.5±11.5,TAS 5（四分位数范围4-7）。术后疼痛明显减轻(VAS: 4.0±2.8 vs. 1.4±1.3；p < 0.001)。与对侧相比，手术膝关节ATT增高（2.5±2.9 mm）；p = <0.01)。4例患者行翻修手术(2例非外伤性不稳定；2例外伤性ACL破裂)。此外，75%的患者恢复了运动，而64.3%的患者可以恢复到以前的水平。结论减坡HTO联合ACLR临床效果好，患者满意度高，失败率低。患者能够恢复活动，但通常是较低的运动水平。与健康侧相比，胫骨前平移仍略有增加。证据水平治疗性研究IV级，病例系列。

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Slope reducing high tibial osteotomy and revision anterior cruciate ligament reconstruction leads to satisfying clinical results and a low failure rate

Purpose

This study aimed to assess clinical and radiological outcomes after two-staged slope-reducing high tibial osteotomy (HTO) and revision anterior cruciate ligament reconstruction (ACLR) for recurrent ACL insufficiency with an increased posterior tibial Slope (PTS) > 12°.

Methods

Patients operated in two centres between 01/2015 and 01/2022 were included after a minimum follow-up of 24 months after revision ACLR. The postoperative pain and the following scores were obtained: IKDC, KOOS, Lysholm, TAS. The Slope was measured using the Dejour technique postoperatively using lateral X-rays being compared to a preoperative X-ray. Also, a clinical examination including range of motion, anterior + posterior translation and pivot-shift were performed. The Rolimeter was used for anterior tibial translation (ATT).

Results

Twenty-four patients (18 m, 6 f; age: 27 ± 8 y) were examined after a mean follow-up of 34 ± 10 months. PTS was reduced from 15.2° ± 2.4° to 5.7° ± 3.8°. Scores at final follow-up: IKDC 75.5 ± 1.5, Lysholm 79.9 ± 12.7, KOOS 77.5 ± 11.5, TAS was 5 (interquartile range 4–7). Postoperative Pain was significantly reduced (VAS: 4.0 ± 2.8 vs. 1.4 ± 1.3; p < 0.001). Compared to the contralateral side, ATT was higher in the operated knee (2.5 ± 2.9 mm; p = <0.01). Four patients underwent revision surgery (2x non-traumatic instability; 2x traumatic ACL rupture). Additionally, 75% of patients returned to sports, while 64.3% of patients could return to their prior level.

Conclusion

Combined slope-reducing HTO and ACLR lead to good clinical outcomes, high patient satisfaction, and a low failure rate. Patients were able to return to activity, but often at a lower sports level. Anterior tibial translation remains slightly increased compared to the healthy side.