骨骼未成熟患者急性前交叉韧带损伤的膝关节形态学危险因素。
Knee morphometric risk factors for acute anterior cruciate ligament injury in skeletally immature patients.
作者信息
Shaw K Aaron, Dunoski Brian, Mardis Neil, Pacicca Donna
机构信息
Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, 300 East Hospital Road, Fort Gordon, GA, 30905, USA,
出版信息
J Child Orthop. 2015 Apr;9(2):161-8. doi: 10.1007/s11832-015-0652-1. Epub 2015 Mar 28.
STUDY DESIGN
Retrospective, case-control.
PURPOSE
Knee morphometric risk factors for noncontact anterior cruciate ligament (ACL) injury have been a popular topic with skeletally mature patients. Little research has focused on the skeletally immature, with conflicting conclusions. This study performs a comprehensive analysis of identified parameters thought to predispose to ACL injury in a skeletally immature cohort.
METHODS
A retrospective review of pediatric patients undergoing knee magnetic resonance imaging (MRI) was performed over a 4-year period. Inclusionary criteria included mid-substance ACL disruption, skeletal immaturity, noncontact injury, without associated ligamentous disruption, and no medical condition associated with ligamentous laxity. MRI studies were analyzed by a pediatric musculoskeletal radiologist, measuring identified bony parameters, and compared with an age-matched control group without ligamentous injury. Data were analyzed using unpaired t-tests and logistic regression.
RESULTS
One hundred and twenty-eight patients sustained an ACL disruption, 39 met all inclusionary criteria (66 excluded for associated ligamentous disruption, 23 skeletally mature, three traumatic mechanisms, one with Marfan syndrome). When compared to an age-matched control cohort, the notch width index (NWI) was found to be significantly smaller in the ACL-injured group (p = 0.046). Subgroups analysis demonstrated significant differences in morphometric parameters between subjects with isolated ACL injuries and concomitant medial collateral ligament (MCL) strain.
CONCLUSIONS
The NWI was significantly smaller in the ACL injury group. Significant differences were noted between isolated ACL injuries and ACL injuries with an MCL strain. This study further highlights the need for incorporating associated injury patterns when investigating the influence of morphometric factors for ACL injury in the skeletally immature.
LEVEL OF EVIDENCE
Level III.
研究设计
回顾性病例对照研究。
目的
对于骨骼成熟的患者，膝关节形态测量危险因素与非接触性前交叉韧带（ACL）损伤一直是热门话题。针对骨骼未成熟患者的研究较少，且结论相互矛盾。本研究对一组骨骼未成熟队列中被认为易导致ACL损伤的已识别参数进行了全面分析。
方法
对4年间接受膝关节磁共振成像（MRI）检查的儿科患者进行回顾性研究。纳入标准包括ACL实质中部断裂、骨骼未成熟、非接触性损伤、无相关韧带断裂，且无与韧带松弛相关的疾病。MRI研究由儿科肌肉骨骼放射科医生进行分析，测量已识别的骨骼参数，并与无韧带损伤的年龄匹配对照组进行比较。数据采用非配对t检验和逻辑回归分析。
结果
128例患者发生ACL断裂，39例符合所有纳入标准（66例因相关韧带断裂排除，23例骨骼成熟，3例创伤机制，1例患有马凡综合征）。与年龄匹配的对照组相比，ACL损伤组的髁间窝宽度指数（NWI）明显更小（p = 0.046）。亚组分析显示，孤立性ACL损伤患者与伴有内侧副韧带（MCL）拉伤患者的形态测量参数存在显著差异。
结论
ACL损伤组的NWI明显更小。孤立性ACL损伤与伴有MCL拉伤的ACL损伤之间存在显著差异。本研究进一步强调，在研究骨骼未成熟患者ACL损伤的形态测量因素影响时，需要考虑相关损伤模式。
证据水平
III级。
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