Shaw Kenneth Aaron, Dunoski Brian S, Mardis Neil J, Pacicca Donna M
Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, 300 East Hospital Road, Fort Gordon, GA, 30905, USA.
Department of Radiology, Children's Mercy Hospital, Kansas City, MO, USA.
Int Orthop. 2016 Mar;40(3):555-60. doi: 10.1007/s00264-015-3026-x. Epub 2015 Nov 5.
Failure of a reconstructed anterior cruciate ligament (ACL) has significant morbidity in the paediatric and adolescent patient population. Untreated concomitant posterolateral corner (PLC) injury is an identified cause of failed ACL reconstruction; however, the injury pattern has yet to be defined for the paediatric population.
Magnetic resonance imaging (MRI) studies of the knee performed between 1 January 2009 and 1 January 2013 were retrospectively reviewed. Imaging reports indicating an intra-substance injury of the ACL were reviewed, and all associated injured structures were recorded. Injury patterns were categorised by age, gender, physis status and associated injuries. Logistic regression and chi-square analyses compared ACL disruptions with and without concomitant PLC injuries.
One hundred and twenty-eight patients (74 boys and 54 girls, average age 15.27 years) sustained an ACL disruption. Concomitant injury to the PLC was seen in 13.3% of injuries. Associated PLC injuries were significantly associated with lateral meniscus injury and Segond fractures. Lateral meniscus injury was predictive of PLC injury (p = 0.05) upon logistic regression analysis.
Concomitant PLC injuries were found in 13.3% of all ACL disruptions on MRI analysis. Lateral meniscus injuries associated with an ACL disruption were predictive of concomitant PLC injury. Combined injury of the ACL and lateral meniscus should prompt close scrutiny to PLC structures.
重建前交叉韧带（ACL）失败在儿童和青少年患者群体中具有显著的发病率。未治疗的合并后外侧角（PLC）损伤是ACL重建失败的一个已明确的原因；然而，儿童群体的损伤模式尚未明确。
回顾性分析2009年1月1日至2013年1月1日期间进行的膝关节磁共振成像（MRI）研究。对表明ACL实质内损伤的影像学报告进行审查，并记录所有相关的损伤结构。根据年龄、性别、骨骺状态和相关损伤对损伤模式进行分类。采用逻辑回归和卡方分析比较有无合并PLC损伤的ACL断裂情况。
128例患者（74例男孩和54例女孩，平均年龄15.27岁）发生了ACL断裂。13.3%的损伤中可见合并PLC损伤。相关的PLC损伤与外侧半月板损伤和Segond骨折显著相关。逻辑回归分析显示外侧半月板损伤可预测PLC损伤（p = 0.05）。
MRI分析显示，在所有ACL断裂中，13.3%存在合并PLC损伤。与ACL断裂相关的外侧半月板损伤可预测合并PLC损伤。ACL和外侧半月板的联合损伤应促使对PLC结构进行仔细检查。
