完全性后外侧半月板根部撕裂与非接触性前交叉韧带损伤中的高度旋转不稳定现象相关。
Complete posterolateral meniscal root tear is associated with high-grade pivot-shift phenomenon in noncontact anterior cruciate ligament injuries.
作者信息
Song Guan-Yang, Zhang Hui, Liu Xin, Zhang Jin, 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):1030-1037. doi: 10.1007/s00167-017-4495-9. Epub 2017 Mar 9.
PURPOSE
The purpose of this study was to investigate whether the complete posterolateral meniscal root tear (PLMRT) would be associated with high-grade pivot-shift phenomenon in noncontact anterior cruciate ligament (ACL) injuries.
METHODS
From 2013 to 2015, a total of 1095 consecutive patients were diagnosed as having noncontact ACL injuries and underwent primary ACL reconstructions. Among them, 140 patients were arthroscopically verified to have concomitant PLMRTs. Application of the exclusion criteria finally left 74 patients who were finally allocated into high-grade pivot-shift (grades II and III) group (n = 51) and low-grade pivot-shift (grades 0 and I) group (n = 23) according to the results of pre-operative pivot-shift tests performed under anesthesia. Predictors of high-grade pivot-shift phenomenon, including degree of PLMRTs, integrity of posterior MFLs, status of lateral meniscal extrusion, age, sex, body mass index (BMI), and KT-1000 arthrometer side-to-side difference (SSD), were assessed by multivariable logistic regression analysis.
RESULTS
The proportion of patients with complete PLMRT in high-grade pivot-shift group was significantly larger than that in low-grade pivot-shift group. In addition, complete PLMRT was significantly [odds ratio (OR) 4.044; 95% CI 1.125-14.534; P = 0.032] associated with high-grade pivot-shift phenomenon in noncontact ACL injury, especially for those with a time from injury to surgery of ≥12 weeks (OR 16.593; 95% CI 1.073-56.695; P = 0.014). However, no significant association was identified between neither the integrity of posterior MFLs nor the status of lateral meniscal extrusion and the high-grade pivot-shift phenomenon.
CONCLUSION
Complete PLMRT is identified to be an independent risk factor of high-grade pivot-shift phenomenon in noncontact ACL injuries, particularly for those with a time from injury to surgery of ≥12 weeks.
LEVEL OF EVIDENCE
IV.
目的
本研究旨在调查完全性后外侧半月板根部撕裂（PLMRT）是否与非接触性前交叉韧带（ACL）损伤中的高级别轴移现象相关。
方法
2013年至2015年，共有1095例连续诊断为非接触性ACL损伤的患者接受了初次ACL重建。其中，140例患者经关节镜证实合并PLMRT。应用排除标准后，最终留下74例患者，根据麻醉下术前轴移试验结果，最终分为高级别轴移（II级和III级）组（n = 51）和低级别轴移（0级和I级）组（n = 23）。通过多变量逻辑回归分析评估高级别轴移现象的预测因素，包括PLMRT的程度、后内侧半月板韧带（MFL）的完整性、外侧半月板挤压情况、年龄、性别、体重指数（BMI）和KT-1000关节测径仪的侧方差异（SSD）。
结果
高级别轴移组中完全性PLMRT患者的比例显著高于低级别轴移组。此外，在非接触性ACL损伤中，完全性PLMRT与高级别轴移现象显著相关[比值比（OR）4.044；95%置信区间（CI）1.125 - 14.534；P = 0.032]，尤其是对于那些受伤至手术时间≥12周的患者（OR 16.593；95% CI 1.073 - 56.695；P = 0.014）。然而，后内侧半月板韧带的完整性和外侧半月板挤压情况与高级别轴移现象之间均未发现显著关联。
结论
完全性PLMRT被确定为非接触性ACL损伤中高级别轴移现象的独立危险因素，特别是对于那些受伤至手术时间≥12周的患者。
证据等级
IV级。
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