Digiacomo Jessica E, Palmieri-Smith Riann M, Redman John A, Lepley Lindsey K
J Sport Rehabil. 2018 Jan 1;27(1):73-82. doi: 10.1123/jsr.2016-0093. Epub 2018 Jan 24.
Modifiable and nonmodifiable risk factors have been identified for sustaining a primary anterior cruciate ligament (ACL) injury; however, less research is available examining risk factors for a second injury. Identifying whether bony morphological factors are different (or more exaggerated) among those that experience a secondary ACL injury is critical to understanding if nonmodifiable risk factors are associated with a second injury.
To determine if bony morphology is different among those that experience a secondary ACL reinjury as compared with those that do not.
Case-control.
University laboratory.
ACL participants were tracked after return to play following primary reconstruction, and if individuals experienced a second ipsilateral injury (ACLx2; n = 14, 8f/6m, 17.9 ± 4.0 y), the primary clinical MRI was analyzed for bony morphological risk factors. ACLx2 participants were matched to individuals (sex, age, height, graft, gender, and activity level) that had undergone reconstruction but did not experience reinjury (ACLx1, n = 14, 8f/6m, 18.7 ± 4.0 y). Ten controls were also enrolled (5m/5f, 20.8 ± 3.9 y) for the purposes of comparing the authors' ACL data against healthy knees.
Lateral and medial posterior tibial slopes (LPTS, MPTS), notch shape index (NSI), and medial tibial plateau depth of concavity (MDC).
All ACL-reconstructed patients (combined ACLx1 and ACLx2 group) had a steeper LPTS than controls (d = 0.87, 95% CI 0.11-1.60, P = .023); however, no difference in LPTS was found between ACLx1 and ACLx2 (P > .05). No differences in MPTS, NSI, and MDC were found between all ACL participants (combined ACLx2 and ACLx1) and controls or between ACLx1 and ACLx2 (P > .05).
Compared to healthy individuals, a steeper LPTS is a common bony abnormality in all ACL-injured participants. Individuals that go on to experience a second ipsilateral ACL injury do not have more exaggerated bony morphology than those that do not suggesting that differences in modifiable risk factors at return to play may contribute to reinjury.
已确定了可改变和不可改变的危险因素，以维持初次前交叉韧带（ACL）损伤；然而，关于二次损伤危险因素的研究较少。确定在经历二次ACL损伤的人群中，骨形态学因素是否不同（或更夸张）对于理解不可改变的危险因素是否与二次损伤相关至关重要。
确定经历二次ACL再损伤的人群与未经历二次损伤的人群相比，骨形态是否不同。
病例对照研究。
大学实验室。
对初次重建后恢复运动的ACL参与者进行跟踪，如果个体经历了第二次同侧损伤（ACLx2；n = 14，8名女性/6名男性，17.9±4.0岁），则分析初次临床MRI的骨形态学危险因素。将ACLx2参与者与接受了重建但未经历再损伤的个体（性别、年龄、身高、移植物、性别和活动水平）进行匹配（ACLx1，n = 14，8名女性/6名男性，18.7±4.0岁）。还招募了10名对照者（5名男性/5名女性，20.8±3.9岁），以便将作者的ACL数据与健康膝关节进行比较。
胫骨后外侧和内侧斜率（LPTS、MPTS）、切迹形状指数（NSI）和胫骨内侧平台凹陷深度（MDC）。
所有ACL重建患者（ACLx1和ACLx2组合组）的LPTS均比对照组更陡（d = 0.87，95%CI 0.11 - 1.60，P = 0.023）；然而，ACLx1和ACLx2之间的LPTS没有差异（P > 0.05）。在所有ACL参与者（ACLx2和ACLx1组合）与对照组之间，以及ACLx
