Abstract:Objective To identify the risk factors of mild rotational instability after anterior cruciate ligament (ACL) reconstruction in short term.Methods The data patients undergoing ACL reconstruction from January 2015 to January 2018 were retrospectively reviewed.Based on the result of pivot shift test in the last follow-up,a total of 22 patients with grade Ⅰ pivot shift test were included in the study group,24 patients with negative pivot shift test were included in the control group.Firstly,the age,gender,BMI,time from injury to surgery,diameter of graft,combined lateral/medial meniscal lesions,distance from tunnel central point to IDEAL point on CT,quadriceps to hamstring Ratio of maximum strength were compared between the two groups using student t test and chi-square test.Secondly,logistic regression was used to analyze the relationship between two groups,in order to identify the risk factors of residual mild rotational instability after ACL reconstruction.Results There were statistically significant differences between two groups in distance from femoral tunnel central point to IDEAL point on CT(P=0.004) and quadriceps to hamstring Ratio of maximum strength(P=0.042).Logistic regression showed that the distance from femoral tunnel central point to IDEAL point on CT(OR=1.18,95%CI:1.04~1.33) and quadriceps to hamstring Ratio of maximum strength (OR=6.65,95%CI:1.13~39.26) are the risk factors of residual mild rotational instability.Conclusion The predictors of residual mild rotational instability after ACL reconstruction included the distance from femoral tunnel central point to IDEAL point on CT and quadriceps to hamstring ratio of maximum strength.The author suggests that intraoperative fluoroscopy could be a safe and easy way to use on the accuracy of femoral tunnel placement in ACL reconstruction.Higher level of hamstring function should be protective of ACL,and improved post ACL reconstruction.
[1]Musahl V,Karlsson J.Anterior cruciate ligament tear[J].N Engl J Med,2019,380(24):2341-2348.
[2]Snoeker B,Turkiewicz A,Magnusson K,et al.Risk of knee osteoarthritis after different types of knee injuries in young adults:a population-based cohort study[J].Br J Sports Med,2020,54(12):725-730.
[3]李宇,张豪,王立志,等.LARS韧带与自体胭绳肌腱重建前交叉韧带的中期疗效比较[J].实用骨科杂志,2019,25(6):509-513.
[4]Rothrauff BB,Jorge A,de Sa D,et al.Anatomic ACL reconstruction reduces risk of posttraumatic osteoarthritis:a systematic review with minimum 10-year follow-up[J].Knee Surg Sports Traumatol Arthrosc,2020,28(4):1072-1084.
[5]Magnussen R,Reinke EK,Huston LJ,et al.Anterior and rotational knee laxity does not affect patient-reported knee function 2 years after anterior cruciate ligament reconstruction[J].Am J Sports Med,2019,47(9):2077-2085.
[6]Culvenor AG,Perraton L,Guermazi A,et al.Knee kinematics and kinetics are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction[J].Osteoarthritis Cartilage,2016,24(9):1548-1553.
[7]Claes S,Hermie L,Verdonk R,et al.Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis[J].Knee Surg Sports Traumatol Arthrosc,2013,21(9):1967-1976.
[8]Katakura M,Nakamura K,Watanabe T,et al.Risk factors for residual anterolateral rotational instability after double bundle anterior cruciate ligament reconstruction:Evaluation by quantitative assessment of the pivot shift phenomenon using triaxial accelerometer[J].Knee,2020,27(1):95-101.
[9]Magnussen RA,Reinke EK,Huston LJ,et al.Factors associated with high-grade Lachman,pivot shift,and anterior drawer at the time of anterior cruciate ligament reconstruction[J].Arthroscopy,2016,32(6):1080-1085.
[10]Musahl V,RahnemaiAzar AA,Costello J,et al.The Influence of Meniscal and Anterolateral Capsular Injury on Knee Laxity in Patients With Anterior Cruciate Ligament Injuries[J].Am J Sports Med,2016,44(12):3126-3131.
[11]Song GY,Zhang H,Wang QQ,et al.Risk factors associated with grade 3 pivot shift after acute anterior cruciate ligament injuries[J].Am J Sports Med,2016,44(2):362-369.
[12]Kittl C,El-Daou H,Athwal KK,et al.The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL deficient knee[J].Am J Sports Med,2016,44(2):345-354.
[13]黄梦全,郭乃铭,彭俊,等。 股骨髁间角与前交叉韧带损伤的相关性分析[J].实用骨科杂志,2018,21(11):998-1001.
[14]Bernard M,Hertel P,Hornung H,et al.Femoral insertion of the ACL:radiographic quadrant method[J].Am J Knee Surg,1997,10(1):14-21.
[15]Stäubli HU,Rauschning W.Tibial attachment area of the anterior cruciate ligament in the extended knee position:anatomy and cryosections in vitro complemented by magnetic resonance arthrography in vivo[J].Knee Surg Sports Traumatol Arthrosc,1994,2(3):138-146.
[16]Parkar AP,Adriaensen M.,Vindfeld S,et al.The anatomic centers of the femoral and tibial insertions of the anterior cruciate ligament:A systematic review of lmaging and cadaveric studies reporting normal center locations[J].Am J Sports Med,2017,45(9):2180-2188.
[17]Pearle AD,McAllister D.Rationale for Strategic Graft Placement in Anterior Cruciate Ligament Reconstruction:IDEAL Femoral Tunnel Position[J].Am J Orthop,2015,44(6):253-258.
[18]Nawabi DH,Tucker S,Schafer KA,et al.ACL fibers near the lateral lntercondylar ridge are the most load bearing during stability examinations and Isometric through passive flexion[J].Am J Sports Med,2016,44(10):2563-2571.
[19]Morgan JA,Dahm D,Levy B,et al.Femoral tunnel malposition in ACL revision reconstruction[J].J Knee Surg,2012,25(5):361-368.
[20]Orsi AD,Canavan PK,Vaziri A,et al.The effects of graft size and insertion site location during anterior cruciate ligament reconstruction on intercondylar notch impingement[J].Knee,2017,24(3):525-535.
[21]李明,刘宁.三入路技术对前交叉韧带重建术骨道、移植物等的影响[J].实用骨科杂志,2019,25(8):700-703.
[22]Inderhaug E,Larsen A,Waaler PA,et al.The effect of intraoperative fluoroscopy on the accuracy of femoral tunnel placement in single-bundle anatomic ACL reconstruction[J].Knee Surg Sports Traumatol Arthrosc,2017,25(4):1211-1218.
[23]Inderhaug E,Larsen A,Strand T,et al.The effect of feedback from post-operative 3D CT on placement of femoral tunnels in single-bundle anatomic ACL reconstruction[J].Knee Surg Sports Traumatol Arthrosc,2016,24(1):154-160.
[24]Bird JH,Carmont MR,Dhillon M,et al.Validation of a new technique to determine mid-bundle femoral tunnel position in anterior cruciate ligament reconstruction using 3-dimensional computed tomography analysis[J].Arthroscopy,2011,27(9):1259-1267.
[25]Cristiani R,Mikkelsen C,Edman G,et al.Age,gender,quadriceps strength and hop test performance are the most important factors affecting the achievement of a patientacceptable symptom state after ACL reconstruction[J].Knee Surg Sports Traumatol Arthrosc,2020,28(2):369-380.
[26]Barber-Westin SD,Noyes FR.Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates:a systematic review[J].Phys Sportsmed,2011,39(3):100-110.
[27]Hewett TE,Di Stasi SL,Myer GD.Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction[J].Am J Sports Med,2013;41(1):216-224.
[28]Palmieri-Smith RM,Strickland M,Lepley LK.Hamstring muscle activity after primary anterior cruciate ligament reconstruction—A protective mechanism in those who do not sustain a secondary lnjury? A preliminary study[J].Sports Health,2019,11(4):316-332.