INCREASED POSTERIOR TIBIAL SLOPE AND VARUS ARE ASSOCIATED WITH A HIGHER RISK OF FAILURE FOLLOWING PRIMARY ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A RETROSPECTIVE COHORT STUDY OF 3,347 PATIENTS
Notice bibliographique
Résumé
Despite favorable clinical outcomes, the risk of revision surgery following Anterior Cruciate Ligament reconstruction (ACLR) remains high (4.1 to 13%). An increased posterior tibial slope (PTS) has been identified as an independent risk factor associated with graft re-rupture. Knee varus has also been associated with altered joint biomechanics and ACLR revision. However, the isolated effect of an increased PTS or knee varus on the risk of revision for graft failure is still ill-defined and not unanimously agreed upon. The main objective of this study was to determine if an increased PTS is independently associated with an increased risk of revision following primary ACLR. The secondary objective was to determine if knee varus is also associated with revision surgery. Retrospective cohort study of all adult patients that underwent primary ACL reconstruction in three academic centers from January 1 st 2010 to January 1 st 2020. The main outcome was defined as revision surgery for graft re-rupture or laxity following primary ACLR. All radiological measurements were made on lateral and antero-posterior knee radiographs. The PTS was defined as the angle between a line parallel to the mid-diaphysis of the tibia and the tibial plateau on a lateral knee radiograph (measures were standardized). Coronal alignment was defined by the medial proximal tibial angle (mPTA), the joint line obliquity (JLO) and the joint line convergence angle (JLCA). Bivariate and multivariate analyses (logistic regression model) were performed. The cohort included 3347 patients aged 30 ± 11 years old in average. 3118 (97%) patients received a hamstring autograft. Three hundred and eleven patients (9.3%) required revision surgery. The main causes for revision surgery were traumatic re-rupture (65%) and postoperative laxity (24%). Patients in the revision group had an increased PTS when compared to patients undergoing primary ACLR (10.1 ± 3.1 versus 8.7 ± 3.1 degrees, p=0.0001, N=1814). Patients in the revision group presented with a PTS > 12 more frequently than patients undergoing primary ACLR (28% vs 13%, p=0.0001, N=1814). When controlling for age, sex, smoking status, chondropathy, meniscal tear and graft type, a posterior tibial slope > 12 significantly increased the risk of revision surgery (odds ratio, 5.3 [3.1–9.2]). Patients in the revision group also presented with a mPTA < 84 degrees (varus) more frequently than patients undergoing primary ACLR (15% versus 9%, p=0.01, N=1814). There was no difference between both groups with regards to JLO and JLCA (p >= 0.05). An increased PTS > 12 degrees is independently associated with a higher risk of revision surgery for graft re-rupture or postoperative laxity. Varus malalignment (mPTA < 84 degrees) is also associated with revision. Future research should focus on the management of the PTS and varus in patients at high risk of failure following ACLR.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».