Buckland-Wright J C, Lynch J A, Dave B
Department of Applied Clinical Anatomy, Guy's, King's, and St Thomas's School of Biomedical Science, King's College London, Guy's Campus, London SE1 1UL, UK.
Ann Rheum Dis. 2000 Aug;59(8):641-6. doi: 10.1136/ard.59.8.641.
To determine, in a preliminary cross sectional study of patients with anterior cruciate ligament (ACL) ruptured knees, which of the radiographic features-subchondral cortical plate thickness, trabecular sclerosis, and osteophytosis-appears before or in association with changes in joint space width (JSW) as a surrogate for articular cartilage thickness in patients with ruptured knees.
19 patients (14 men), mean (95% CI) age 28.7 (23.6 to 33.8) years, had ACL rupture in one knee only, confirmed by arthroscopy. Anterior draw, Lachman's test, and pivot shift tests were performed and x5 posteroanterior macroradiographs of both knees in a standing semiflexed view were taken at a mean (95% CI) time from injury of 34. 3 (26.9 to 41.7) months. In each radiograph, computerised methods were used to measure minimum JSW and fractal signature analysis (FSA) to quantify the vertical and horizontal trabecular organisation, osteophyte area, and the subchondral cortical plate thickness, in the medial and lateral tibial compartments of all knees.
Physical examination confirmed the presence of joint laxity in the injured knees. No statistical difference in either medial or lateral JSW and subchondral cortical plate thickness was detected between ACL ruptured and uninjured knees. FSA showed a significant decrease in fractal dimension for the horizontal trabeculae (size 0.42 mm) in the medial compartment of the ACL ruptured knees compared with the uninjured knees (p<0.01, multivariate analysis of variance). There was an inverse correlation (R -0.74) between the time since knee injury and the difference in FSA values for ACL ruptured and uninjured knees in medial compartment horizontal trabeculae (size 0.4 mm). No significant changes were detected in the lateral compartment. Osteophytes were detected in the medial compartment of nine ACL injured knees.
Compared with the uninjured knee, ACL rupture leads to thickening of subchondral horizontal trabeculae (decreased FSA) in the medial tibial compartment of all knees, reaching significance at about four years after injury. Osteophytes were present in the same compartment in 9/19 knees. No changes in JSW and subchondral cortical plate thickness were detected. Whether the bony changes detected in these ACL ruptured knees presage those of early osteoarthritis requires further study.
在一项对前交叉韧带（ACL）断裂膝关节患者的初步横断面研究中，确定哪些影像学特征——软骨下皮质板厚度、小梁硬化和骨赘形成——在膝关节损伤患者中先于关节间隙宽度（JSW）变化出现或与关节间隙宽度变化相关，而关节间隙宽度变化可作为关节软骨厚度的替代指标。
19例患者（14例男性），平均（95%可信区间）年龄28.7（23.6至33.8）岁，仅一侧膝关节发生ACL断裂，经关节镜检查确诊。进行前抽屉试验、拉赫曼试验和轴移试验，并在平均（95%可信区间）受伤后34.3（26.9至41.7）个月时，拍摄双膝关节站立半屈曲位的5张后前位大X线片。在每张X线片中，使用计算机方法测量最小JSW，并采用分形特征分析（FSA）量化所有膝关节内侧和外侧胫骨平台的垂直和水平小梁结构、骨赘面积以及软骨下皮质板厚度。
体格检查证实受伤膝关节存在关节松弛。ACL断裂膝关节与未受伤膝关节在内外侧JSW和软骨下皮质板厚度方面均未检测到统计学差异。FSA显示，与未受伤膝关节相比，ACL断裂膝关节内侧平台水平小梁（尺寸0.42mm）的分形维数显著降低（p<0.01，多因素方差分析）。膝关节受伤时间与ACL断裂膝关节和未受伤膝关节内侧平台水平小梁（尺寸0.4mm）的FSA值差异之间存在负相关（R=-0.74）。外侧平台未检测到显著变化。在9例ACL损伤膝关节的内侧平台发现了骨赘。
与未受伤膝关节相比，ACL断裂导致所有膝关节内侧胫骨平台软骨下水平小梁增厚（FSA降低），在受伤约四年后达到显著水平。19例中有9例膝关节的同一部位出现了骨赘。未检测到JSW和软骨下皮质板厚度的变化。这些ACL断裂膝关节中检测到的骨质改变是否预示着早期骨关节炎的改变，需要进一步研究。
