Tuca Maria, Hayter Catherine, Potter Hollis, Marx Robert, Green Daniel W
Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Manquehue 1410, Santiago, Chile.
Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
Knee Surg Sports Traumatol Arthrosc. 2016 Mar;24(3):780-7. doi: 10.1007/s00167-016-4021-5. Epub 2016 Feb 9.
Increasing numbers of children and adolescents are being treated for ACL tears. In order for surgeons to safely optimize treatment during ACL surgery, we must better understand ACL growth and intercondylar notch patterns in the skeletally immature knee. The aim of this study is to measure ACL and intercondylar notch volume in paediatric patients and observe how these volumes change as a function of age and gender.
Data were extracted from the picture archiving and communication systems (PACS) computer records. Sample consisted of 137 MRI knee examinations performed between January 2006 and July 2010 in patients aged 3-13. Subjects were grouped into 1-year age intervals. Patients with imaging reports including ACL tears, previous surgeries, congenital structural anomalies, or syndromes were excluded.
Measures of ACL volume significantly increased with age (P < 0.001). A linear increase in ACL volume was observed until the age 10, with a mean increase in volume of 148 mm(3) per age group. ACL volume plateaued at 10 years, after which minimal increase in ACL volume was observed. Sex was not found to be a significant predictor of ACL volume in the multiple linear regression (P = 0.57). Similar to ACL volume, there was a significant increase in intercondylar notch volume with age with a mean increase of 835 mm(3) per age group (P < 0.0001). Intercondylar notch volume reached a plateau at age 10, after which a minimal increase in notch volume was observed in older groups. Female patients had notch volumes that were on average 892 + 259 mm(3) smaller than male patients who were in the same age group (P = 0.0006).
The plateau in the growth of ACL and notch volume occurs at age 10, prior to the halt in longitudinal growth of boys and girls. Female patients have significantly smaller intercondylar notch volumes than their age-matched male counterparts, while no gender difference was seen in ACL volume. These results suggest that notch volume is an intrinsically sex-specific difference, which may contribute to the higher rate of ACL tears among females. These growth patterns are clinically relevant as it allows surgeons to better understand the anatomy, pathology, and risk factors related to ACL tears and its reconstruction.
Observational Study, Level IV.
接受前交叉韧带（ACL）撕裂治疗的儿童和青少年数量日益增加。为使外科医生在ACL手术期间能安全地优化治疗方案，我们必须更好地了解骨骼未成熟膝关节中ACL的生长情况及髁间切迹模式。本研究的目的是测量儿科患者的ACL和髁间切迹容积，并观察这些容积如何随年龄和性别的变化而改变。
数据从图像存档与通信系统（PACS）计算机记录中提取。样本包括2006年1月至2010年7月间对3至13岁患者进行的137例膝关节MRI检查。受试者按1岁年龄间隔分组。排除有包括ACL撕裂、既往手术、先天性结构异常或综合征等影像学报告的患者。
ACL容积测量值随年龄显著增加（P < 0.001）。在10岁之前观察到ACL容积呈线性增加，每个年龄组的平均增加量为148 mm³。ACL容积在10岁时趋于平稳，此后观察到ACL容积的增加极少。在多元线性回归中，性别未被发现是ACL容积的显著预测因素（P = 0.57）。与ACL容积类似，髁间切迹容积也随年龄显著增加，每个年龄组的平均增加量为835 mm³（P < 0.0001）。髁间切迹容积在10岁时达到平稳，此后在年龄较大的组中观察到切迹容积的增加极少。女性患者的切迹容积平均比同年龄组男性患者小892 + 259 mm³（P = 0.0006）。
ACL和切迹容积生长的平稳期出现在10岁，早于男孩和女孩纵向生长停止的时间。女性患者的髁间切迹容积明显小于年龄匹配的男性患者，而在ACL容积方面未发现性别差异。这些结果表明切迹容积是一种内在的性别特异性差异，这可能是女性中ACL撕裂发生率较高的原因之一。这些生长模式具有临床相关性，因为它能让外科医生更好地理解与ACL撕裂及其重建相关的解剖结构、病理情况和危险因素。
观察性研究，IV级。
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