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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Preoperative Knee Instability Affects Residual Instability as Evaluated by Quantitative Pivot-Shift Measurements During Double-Bundle ACL Reconstruction
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Preoperative Knee Instability Affects Residual Instability as Evaluated by Quantitative Pivot-Shift Measurements During Double-Bundle ACL Reconstruction

机译：术前膝关节不稳定性会影响剩余不稳定，通过定量枢轴转换测量在双束ACL重建期间评估

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Background: The pivot-shift test is an important indicator of functional outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR). Preoperative instability as indicated by the pivot-shift test is associated with residual instability after ACLR. Few studies have used quantitative means to evaluate the pivot shift after ACLR. Purpose: To investigate the relationship between preoperative and residual instability and to identify the risk factors for residual instability by using quantitative measurements of the pivot shift. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 91 patients undergoing primary double-bundle ACLR were retrospectively enrolled. Quantitative measurements of instability for ACL-deficient knees (ACLD) and uninjured contralateral knees (intact) preoperatively, as well as ACLR knees intraoperatively, were performed under general anesthesia using the pivot-shift test, with inertial sensors to measure acceleration and external rotational (ER) angular velocity. The ratios of intact to ACLD (ACLD/I) and intact to ACLR (ACLR/I) were measured. Patients who showed an ACLR/I of &1 were classified into the residual instability group, and those with an ACLR/I of ≤1 were classified into the noninstability group. Regarding demographic, surgical, and quantitative measurement factors, between-group comparisons and multivariate logistic regression were conducted for predictors of residual instability. Receiver operating characteristic curves were used to evaluate the correlations between ACLD/I and ACLR/I and the cutoff value of ACLD/I in predicting residual instability. Results: The predictive factors for intraoperative residual instability included female sex (odds ratio [OR], 0.3 [95% CI, 0.1-0.9]; P = .034) and ACLD/I for acceleration (OR, 1.6 [95% CI, 1.2-2.1]; P & .001), and ACLD/I for ER angular velocity (OR, 1.9 [95% CI, 1.2-3.1]; P = .013). Correlations between ACLD/I and ACLR/I were moderate with respect to both acceleration ( r = 0.435; P & .001) and ER angular velocity ( r = 0.533; P & .001). The cutoff points for ACLD/I were 4.9 for acceleration (sensitivity, 65.1%; specificity, 85.7%; area under the curve [AUC], 0.76) and 2.4 for ER angular velocity (sensitivity, 80.0%; specificity, 50.0%; AUC, 0.74). Conclusion: Greater preoperative instability was a risk factor for residual instability as measured intraoperatively by a quantitatively evaluation in the pivot shift during ACL reconstruction. Quantitative measurements of instability during the pivot shift mechanism under general anesthesia may enable surgeons to predict postoperative residual instability.
机译：背景：枢转换档试验是前十字韧带（ACL）重建（ACLR）后功能结果的重要指标。如枢轴转换测试所示的术前不稳定性与ACLR之后的残余不稳定性相关。很少有研究使用定量手段来评估ACLR之后的枢轴偏移。目的：研究术前和残留不稳定性之间的关系，并通过使用枢轴偏移的定量测量来确定残余不稳定性的危险因素。研究设计：案例控制研究;证据水平，3.方法：回顾性地注册了91例接受初级双束ACLR的91名患者。通过枢轴转换试验在全身麻醉下进行术前测量ACL缺陷膝盖（ACLD）和未加注的对侧膝盖（完整的腹侧膝盖（完整），以及惯性传感器，以测量加速和外部旋转的惯性传感器（ ER）角速度。测量完整对ACLD（ACLD / I）并完整于ACLR（ACLR / I）的比率。显示ACLR / I的患者＆GT; 1分为残留不稳定组，≤1的ACLR / I的患者被分类为不恒定组。关于人口统计学，手术和定量测量因子，对剩余不稳定性的预测器进行了组比较和多变量逻辑回归。接收器操作特性曲线用于评估ACLD / I和ACLR / I之间的相关性以及ACLD / I的截止值，以预测残余不稳定性。结果：术中残留不稳定性的预测因素包括女性（差距[或]，0.3 [95％CI，0.1-0.9]; P = .034）和ACLD / I用于加速（或1.6 [95％CI， 1.2-2.1]; p＆ .001），ACLD / I用于ER角速度（或1.9 [95％CI，1.2-3.1]; p = .013）。 ACLD / I和ACLR / I之间的相关性相对于加速度（r = 0.435; p＆ 001）和ER角速度（r = 0.533; p＆ .001）。 ACLD / I的截止点为4.9，用于加速度（敏感性，65.1％;特异性，85.7％;曲线下的面积为0.76）和2.4，用于ER角速度（敏感性，80.0％;特异性，50.0％; AUC ，0.74）。结论：更高的术前不稳定性是残留不稳定性的危险因素，以通过在ACL重建期间的枢转偏移中的定量评估来测量。在全身麻醉下枢转换档机制期间不稳定性的定量测量可以使外科医生能够预测术后残留不稳定性。

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