Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
J Bone Joint Surg Am. 2011 Jun 15;93(12):1096-103. doi: 10.2106/JBJS.J.00929.
Little is known about early morphologic change occurring with an acute injury of the anterior cruciate ligament. Magnetic resonance imaging was used in this study to investigate the two-year change in cartilage thickness, bone marrow lesions, and joint fluid of knees with acute anterior cruciate ligament injury treated surgically or nonsurgically and to identify factors associated with these changes.
Sixty-one subjects (sixteen women and forty-five men with a mean age of twenty-six years) with acute anterior cruciate ligament injury to a previously uninjured knee were examined with use of a 1.5-T magnetic resonance imaging scanner at baseline and at three, six, twelve, and twenty-four months after the injury. Thirty-four subjects received rehabilitation and early anterior cruciate ligament reconstruction (a median of 44.5 days after the injury), eleven subjects received rehabilitation and a delayed anterior cruciate ligament reconstruction (408 days), and sixteen received rehabilitation alone. Morphologic measures were obtained from computer-assisted segmentation of magnetic resonance images. Factors tested for association were age, sex, activity level, treatment, and osteochondral fracture at baseline.
After twenty-four months, significant cartilage thinning occurred in the trochlea of the femur (mean, -4.3%; standard response mean = 0.88), whereas significant cartilage thickening occurred in the central medial aspect of the femur (mean, +2.7%; standard response mean = 0.46). A younger age at the time of injury was a risk factor for thickening in the central medial aspect of femur, whereas older age at injury was a risk factor for thinning in the trochlea of the femur. Treatment of the torn anterior cruciate ligament was not related to these changes nor was activity level or an osteochondral fracture at baseline. Posttraumatic bone marrow lesions in the lateral aspect of the tibia resolved completely in fifty-four of fifty-eight knees (median, six months) and lesions in the lateral aspect of the femur resolved completely in forty-four of forty-seven knees (median, three months); however, thirty new bone marrow lesions developed in the lateral aspect of twenty-one knees over the two-year period. None of the factors were related to the development of bone marrow lesions.
Morphologic change as visualized on magnetic resonance imaging occurs in the knee over the first two years after acute anterior cruciate ligament injury as demonstrated by cartilage thickening (central medial aspect of the femur), cartilage thinning (trochlea of the femur), the resolution of posttraumatic bone marrow lesions in the lateral part of the knee, and the development of new bone marrow lesions laterally. Age and male sex were independent risk factors for change in cartilage morphology.
对于前交叉韧带急性损伤后早期的形态学变化知之甚少。本研究采用磁共振成像（MRI）来研究手术或非手术治疗的急性前交叉韧带损伤膝关节的软骨厚度、骨髓病变和关节积液的两年变化，并确定与这些变化相关的因素。
61 名受试者（16 名女性和 45 名男性，平均年龄 26 岁），均为初次受伤的膝关节急性前交叉韧带损伤，在基线和损伤后 3、6、12 和 24 个月时使用 1.5T 磁共振成像扫描仪进行检查。34 名受试者接受康复和早期前交叉韧带重建（中位数为损伤后 44.5 天），11 名受试者接受康复和延迟前交叉韧带重建（408 天），16 名受试者仅接受康复治疗。形态学测量是通过磁共振图像的计算机辅助分割获得的。测试的相关因素包括年龄、性别、活动水平、治疗和基线时的骨软骨骨折。
24 个月后，股骨滑车的软骨明显变薄（平均-4.3%；标准反应均值=0.88），而股骨中央内侧的软骨明显增厚（平均+2.7%；标准反应均值=0.46）。受伤时年龄较小是股骨中央内侧软骨增厚的危险因素，而受伤时年龄较大是股骨滑车软骨变薄的危险因素。撕裂前交叉韧带的治疗与这些变化无关，活动水平或基线时的骨软骨骨折也无关。胫骨外侧的创伤性骨髓病变在 58 个膝关节中的 54 个（中位数，6 个月）中完全消退，股骨外侧的病变在 47 个膝关节中的 44 个（中位数，3 个月）中完全消退；然而，在两年期间，21 个膝关节中的 21 个又出现了 30 个新的骨髓病变。这些因素均与骨髓病变的发展无关。
急性前交叉韧带损伤后两年内，膝关节磁共振成像显示形态学变化，包括软骨增厚（股骨中央内侧）、软骨变薄（股骨滑车）、膝关节外侧创伤性骨髓病变的消退以及外侧新骨髓病变的发展。年龄和男性是软骨形态变化的独立危险因素。
