Yüksel Halil Yalçin, Erkan Serkan, Uzun Macit
Third Orthopedics and Traumatology Clinic, Ankara Numune Educational and Research Hospital, Ankara, Turkey.
Knee Surg Sports Traumatol Arthrosc. 2006 Nov;14(11):1139-47. doi: 10.1007/s00167-006-0170-2. Epub 2006 Aug 23.
The purpose of this study was to evaluate arthroscopically the type, localization and prevalence of the meniscal and chondral lesions accompanying complete rupture of the anterior cruciate ligament (ACL) in patients who elected not to restrict their daily activities after the initial trauma. The size of the chondral lesions was also evaluated. Our second aim is to analyze the effects of age, time from injury, and both age and time from injury in the presence or absence of accompanying lesions in these patients. The localization and type of the accompanying lesions of 317 knees with complete rupture of the ACL were recorded by the same observer. We applied therapeutic arthroscopy to all patients after their first visit to our clinic. All of the patients were military personnel and their history revealed that they had elected to not restrict their occupational activities after the first trauma causing ACL insufficiency. We defined the first 6 week period after the initial trauma as the acute, 6 weeks to 12 months as the subchronic and 12 months or longer as the chronic period. The average time from injury to arthroscopy for these patients, who were all male, was 19.4 +/- 20.3 months. Eighty-one percent of the patients had at least one meniscal tear, and 45.1% had at least one chondral lesion. The mean ages at the time of surgery of patient groups with or without medial and lateral menisci lesions were compared, and no statistically significant difference was determined. In the chronic period, the relative risk (RR) values of meniscal tears were 7.75 for medial and 2.40 for lateral. The group consisting of patients with chondral lesions was compared with the group of patients without chondral lesions in terms of their ages and the time from injury to arthroscopy, and the difference was statistically significant. The RR value for patients with co-existence of at least two lesions was 1.761 for more than 30 years of age. The RR values for at least two lesions were 2.356 for the subchronic and 14.909 for the chronic group when compared to the acute group. The RR values in patients more than 30 years of age in the chronic group were 13.58 for medial meniscus, 3.21 for lateral meniscus and 71.88 for chondral lesions when compared to patients less than 30 years of age in the acute group. It is important to note that the combined effects of advanced age and prolonged time from injury in patients who elected to not restrict occupational activities are more severe due to the increase in the occurrence of intraarticular lesions accompanying ACL insufficiency as compared to their separate effects.
本研究的目的是通过关节镜评估在初次创伤后未限制日常活动的患者中，前交叉韧带（ACL）完全断裂所伴随的半月板和软骨损伤的类型、位置及发生率。同时评估软骨损伤的大小。我们的第二个目的是分析年龄、受伤时间以及年龄和受伤时间对这些患者中是否存在伴随损伤的影响。由同一名观察者记录317例ACL完全断裂膝关节的伴随损伤的位置和类型。在所有患者首次就诊于我们诊所后，我们对其进行了治疗性关节镜检查。所有患者均为军人，他们的病史显示，在首次导致ACL功能不全的创伤后，他们选择不限制职业活动。我们将初次创伤后的前6周定义为急性期，6周至12个月为亚慢性期，12个月及更长时间为慢性期。这些均为男性患者，从受伤到关节镜检查的平均时间为19.4±20.3个月。81%的患者至少有一处半月板撕裂，45.1%的患者至少有一处软骨损伤。比较了有或无内侧和外侧半月板损伤的患者组手术时的平均年龄，未发现统计学上的显著差异。在慢性期，内侧半月板撕裂的相对风险（RR）值为7.75，外侧为2.40。比较了有软骨损伤的患者组和无软骨损伤的患者组在年龄和从受伤到关节镜检查的时间方面的情况，差异具有统计学意义。年龄超过30岁且至少存在两种损伤的患者的RR值为1.761。与急性期组相比，亚慢性组至少两种损伤的RR值为2.356，慢性组为14.909。与急性期年龄小于30岁的患者相比，慢性组年龄超过30岁的患者内侧半月板的RR值为13.58，外侧半月板为3.21，软骨损伤为71.88。需要注意的是，与单独的影响相比，在选择不限制职业活动的患者中，高龄和受伤时间延长的综合影响更为严重，因为伴随ACL功能不全的关节内损伤发生率增加。
