This project aims to establish a high-quality, large-scale, single-center bidirectional cohort study to evaluate the postoperative clinical efficacy of ACLR combined with ALC augmentation in a specific high-risk population-patients with ACL rupture exhibiting excessive internal tibial rotation subluxation (EIRTS) on preoperative MRI. The study population will consist of patients with primary ACL rupture, and high-risk individuals will be identified based on the presence of EIRTS on preoperative knee MRI. The exposure group will undergo ACLR combined with ALC augmentation, while the control group will receive standard ACLR. Observational indicators will include all baseline patient characteristics and postoperative clinical outcomes.
Anterior cruciate ligament (ACL) rupture is one of the most common sports injuries in the field of sports medicine and significantly impairs athletic function. Autologous hamstring tendon single-bundle ACL reconstruction (ACLR) is the standard surgical technique for treating ACL rupture. Although most patients can return to sports postoperatively, a subset still experiences graft re-rupture, residual rotational instability of the knee, and other cases of reconstruction failure. Recent studies suggest that concomitant injury to the anterolateral complex (ALC) of the knee may be an important contributing factor. However, there is currently a lack of clinical evidence regarding the diagnosis of ALC injuries and the surgical indications for their treatment. Therefore, whether ALC should be augmented (diagnostic and surgical indications) in addition to routine ACLR, and how it should be augmented (surgical techniques), has become a key focus of current research. This project aims to establish a high-quality, large-scale, single-center bidirectional cohort study to evaluate the postoperative clinical efficacy of ACLR combined with ALC augmentation in a specific high-risk population-patients with ACL rupture exhibiting excessive internal tibial rotation subluxation (EIRTS) on preoperative MRI. The study population will consist of patients with primary ACL rupture, and high-risk individuals will be identified based on the presence of EIRTS on preoperative knee MRI. The exposure group will undergo ACLR combined with ALC augmentation, while the control group will receive standard ACLR. Observational indicators will include all baseline patient characteristics and postoperative clinical outcomes. The study includes two follow-up time points: 2 years and 5 years postoperatively. Follow-up will be conducted via outpatient visits and telephone interviews. Based on the follow-up outcomes, multivariate regression models will be used to analyze the association between exposure and clinical outcomes. This cohort study aims to address treatment strategies for high-risk ACL rupture patients with preoperative EIRTS, thereby improving perioperative management and clinical decision-making in ACL injuries. It will provide important clinical evidence for establishing surgical indications for ALC augmentation and contribute to the development of long-term clinical prediction models for graft failure after ACLR. The findings will support innovation in ACL reconstruction techniques, optimization of perioperative strategies, reduction in postoperative graft failure rates, and improvement in return-to-sport rates. This study holds significant implications for advancing clinical research in the field of sports medicine.
Study Type
OBSERVATIONAL
Enrollment
335
Peking University Third Hospital
Beijing, China
Graft Failure Rate
Graft failure was identified based on physical examination findings and postoperative MRI scans at the designated follow-up time points.
Time frame: At 2 and 5 years postoperatively
Return to Pivoting Sports: Rate and Time
The rate and timing of return to pivoting sports were recorded at each follow-up time point.
Time frame: At 2 and 5 years postoperatively
Patient-Reported Outcome Measures
Patient-reported outcome measures (PROMs) were collected at each follow-up time point using standardized questionnaires, including the Visual Analogue Scale for Pain (VAS), Tegner Activity Score, modified Lysholm Knee Scoring Scale, and the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form.
Time frame: At 2 and 5 years postoperatively
Physical Examinations
Physical examinations were performed at each follow-up visit, including the anterior drawer test, Lachman test, pivot-shift test, and KT-2000 arthrometer assessment.
Time frame: At 2 and 5 years postoperatively
Muscle Strength
Isokinetic muscle strength testing of the knee extensors and flexors was performed using the Biodex system.
Time frame: At 2 and 5 years postoperatively
MRI Measurements
Postoperative MRI scans were scheduled for all patients to assess tibiofemoral position, osteoarthritis progression, and ACL graft signal intensity as indicators of graft healing, including anterior tibial subluxation (ATS), internal rotational tibial subluxation (IRTS), cartilage thickness and the signal-to-noise quotient (SNQ).
Time frame: At 2 and 5 years postoperatively
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