在急性前交叉韧带损伤后，存在高度轴移现象的患者前外侧韧带损伤的患病率更高。
Patients with high-grade pivot-shift phenomenon are associated with higher prevalence of anterolateral ligament injury after acute anterior cruciate ligament injuries.
作者信息
Song Guan-Yang, Zhang Hui, Wu Guan, Zhang Jin, Liu Xin, Xue Zhe, Qian Yi, Feng Hua
机构信息
Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2017 Apr;25(4):1111-1116. doi: 10.1007/s00167-017-4492-z. Epub 2017 Feb 27.
PURPOSE
To compare the prevalence of concomitant anterolateral ligament (ALL) injury between patients with high-grade (grades II and III) pivot-shift and those with low-grade (grades 0 and I) pivot-shift phenomenon after acute anterior cruciate ligament (ACL) injuries.
METHODS
Sixty-eight patients with an acute ACL injury who showed high-grade (grades II and III) pivot-shift phenomenon were enrolled as the study group. They were matched in a 1:1 fashion to another 68 ACL-injured control participants who showed low-grade (grades 0 and I) pivot-shift phenomenon during the same study period. Patients were matched by age, sex, and time from injury to surgery. A standardized pivot-shift test was performed under anesthesia for all the patients. Two blinded musculoskeletal radiologists reviewed the magnetic resonance imaging (MRI) scans for the presence of concomitant ALL injury. The grade of an ALL injury was divided into grade 0 (normal), grade I (sprain), grade II (partial tear), and grade III (complete tear). The prevalence and the grade of concomitant ALL injury were further compared between the study group and the control group.
RESULTS
Overall, the prevalence of concomitant ALL injury in the study group (94.1%, 64/68) was significantly higher than that in the control group [60.3%, (41/68), P < 0.05]. Specifically, there were 49 patients (49/64, 76.6%) who showed grade II/III (partial/complete tear) MRI evidence of concomitant ALL injury, which was also significantly higher than that in the control group (12/41, 29.3%).
CONCLUSIONS
Patients with high-grade pivot-shift phenomenon showed higher prevalence of concomitant ALL injury compared to those with low-grade pivot-shift phenomenon after acute ACL injuries. Careful assessment and proper treatment of this concomitant injury should be considered especially in knees with high-grade pivot-shift phenomenon.
LEVEL OF EVIDENCE
III.
目的
比较急性前交叉韧带（ACL）损伤后，伴有高级别（Ⅱ级和Ⅲ级）轴移的患者与伴有低级别（0级和Ⅰ级）轴移现象的患者中，前外侧韧带（ALL）损伤的发生率。
方法
68例表现为高级别（Ⅱ级和Ⅲ级）轴移现象的急性ACL损伤患者被纳入研究组。在同一研究期间，以1:1的比例将他们与另外68例表现为低级别（0级和Ⅰ级）轴移现象的ACL损伤对照参与者进行匹配。患者按年龄、性别和受伤至手术的时间进行匹配。所有患者在麻醉下进行标准化轴移试验。两名盲法肌肉骨骼放射科医生对磁共振成像（MRI）扫描结果进行评估，以确定是否存在ALL合并损伤。ALL损伤的分级分为0级（正常）、Ⅰ级（扭伤）、Ⅱ级（部分撕裂）和Ⅲ级（完全撕裂）。进一步比较研究组和对照组中ALL合并损伤的发生率和分级。
结果
总体而言，研究组中ALL合并损伤的发生率（94.1%，64/68）显著高于对照组[60.3%，（41/68），P＜0.05]。具体而言，有49例患者（49/64，76.6%）的MRI显示有Ⅱ/Ⅲ级（部分/完全撕裂）ALL合并损伤的证据，这也显著高于对照组（12/41，29.3%）。
结论
急性ACL损伤后，伴有高级别轴移现象的患者与伴有低级别轴移现象的患者相比，ALL合并损伤的发生率更高。尤其是对于伴有高级别轴移现象的膝关节，应考虑对这种合并损伤进行仔细评估和适当治疗。
证据级别
Ⅲ级。
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