前交叉韧带重建后12个月的MRI可以识别随后移植物破裂的危险因素，并用于指导恢复运动。来自高容量机构的结果。

IF 3.3 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2025-08-21 DOI:10.1016/j.jisako.2025.100994

Christian Lutz , Fabio Mancino , David A. Parker

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引用次数: 0

摘要

导读：据报道，前交叉韧带重建后再次撕裂的发生率在6%至31%之间，导致更差的结果，并增加了创伤后骨关节炎的风险。本研究调查了术后磁共振成像评估、临床结果和恢复运动测试结果是否有助于识别早期移植物再撕裂风险较高的患者。方法：回顾性分析2017 - 2022年间430例采用自体腘绳肌腱移植行原发性前交叉韧带重建术的患者，随访时间至少为12个月。收集基线特征、术中及术后信息。通过12个月的磁共振成像评估移植物信号、隧道拓宽和定位。经历早期移植物再撕裂的患者与匹配队列的比例为1:4进行比较。比较连续变量。采用Logistic回归和方差分析来确定危险因素及其与再撕裂的关系。结果：在符合纳入/排除标准的346例患者中，随访12个月后19例发生移植物破裂（5.4%）。其中6例患者因术后1年磁共振成像缺失而被排除。总的来说，13名患者被纳入再撕裂组，与50名匹配的患者相比。平均随访时间为23.6±4.2个月（18 ~ 36个月）。12个月的磁共振成像显示，再次撕裂的信噪比更高（2.93 vs 2.02; p=0.029）。方差分析显示移植物信号与再撕裂之间存在正交互作用（方差分析，p=0.028）。隧道定位在两组间具有可比性，且与再次撕裂无关。同样，胫骨和股骨隧道拓宽在两组之间具有可比性，与移植物再撕裂无关（方差分析，p=0.733和p=0.190）。在再撕裂组中，更大比例的患者在一年内出现前膝关节松弛>2mm （83.3% vs 38.8%, p=0.058）。然而，平均松弛度具有可比性（2.55 mm vs 1.35 mm; p=0.189）。临床得分和回归运动测试没有差异。结论：12个月磁共振成像显示移植物信号较高，表明移植物愈合较差，与早期前交叉韧带再撕裂有关。前交叉韧带重建后的磁共振成像可以指导后续治疗。需要进一步的研究来证实这些初步发现。证据水平iii：回顾性比较研究。

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Twelve-month magnetic resonance imaging after anterior cruciate ligament reconstruction can identify risk factors for subsequent graft rupture and used to guide the return to sport. Results from a high-volume institution

Introduction

Retear after anterior cruciate ligament reconstruction (ACLR) has been reported between 6% and 31% of cases, resulting in worse outcomes and increased risk of post-traumatic osteoarthritis. This study investigated whether postoperative magnetic resonance imaging (MRI) assessment, clinical outcomes, and return-to-sport test findings can help identify patients at higher risk of early graft retear.

Methods

Retrospective analysis of 430 patients who underwent primary ACLR using hamstring autograft between 2017 and 2022, with a minimum follow-up of 12 months. Baseline characteristics, intraoperative, and postoperative information were collected. Graft signal, tunnel widening and positioning were assessed through a 12-month MRI. Patients who experienced early graft retear were compared with a matched cohort with a ratio of 1:4. Continuous variables were compared. Logistic regression and analysis of variance were used to identify risk factors and association with retear. p values < 0.05 were considered significant.

Results

Of the 346 patients who met the inclusion/exclusion criteria, 19 experienced a graft rupture (5.4 %) after the 12-months follow-up. Of those, six patients were excluded due to missing postoperative 1-year MRI. Overall, 13 patients were included in the retear group and compared with 50 matched patients. The mean follow-up was 23.6 ± 4.2 months (range, 18–36 months). The 12-month MRI showed a greater signal-to-noise quotient (SNQ) in case of retear (2.93 vs 2.02; p = 0.029). The analysis of variance showed a positive interaction between graft signal and retear (analysis of variance [ANOVA], p = 0.028). Tunnel positioning was comparable between the groups, and not associated with retear. Similarly, tibial and femoral tunnel widening were comparable between the two groups and not associated with graft retear (ANOVA, p = 0.733 and p = 0.190). A greater proportion of patients had an anterior knee laxity >2 mm at one year in the retear group (83.3% vs 38.8 %, p = 0.058). However, mean laxity was comparable (2.55 mm vs 1.35 mm; p = 0.189). No differences were noted for clinical scores and return-to-sport testing.

Conclusion

Higher graft signal on MRI at 12 months, indicating poorer graft healing, is associated with early anterior cruciate ligament retear. Resonance imaging after ACLR could be used to guide the follow-up management. Further research is required to confirm these preliminary findings.