Trauma and Orthopaedics Department, Homerton University Hospital, Homerton Row, London, E9 6SR, UK.
AMR Advanced Medical Research, Hofenstrasse 89b, 8708, Männedorf, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2018 Apr;26(4):1252-1257. doi: 10.1007/s00167-017-4625-4. Epub 2017 Jun 23.
The principal purpose of this paper was to identify whether femoral notch morphology was different in females without anterior cruciate ligament (ACL) injury from those with ACL injury. Magnetic resonance imaging (MRI) was used to assess the femoral notch type, notch width index and 'α angle' in female patients and measure these differences.
This is a retrospective case control study of 119 female patients, 58 with ACL injury and 61 patients without ACL injury who underwent knee MRI between March 2014 and April 2016. The morphometric measurements were taken by two independent observers. The femoral notch width index was calculated as the ratio between the central notch width and transcondylar or intercondylar width; values >0.27 were considered normal. The femoral notch shape was classified as Type A, Type U or Type W, with Type A describing a stenotic notch, Type U a notch with a wider contour and Type W a wider Type U with two apices apparent. The angle between the longitudinal femoral axis and the Blumensaat line was identified as the 'α angle'. The statistical analysis was performed with t tests, simple and multivariable logistic regression analysis to evaluate the strength of these specific femoral notch morphometric values as predictive factors to ACL rupture.
Stenotic femoral notch Type A was identified as a high risk factor to ACL injury (odds ratio [OR] = 2.8; p = 0.03). There was no significant difference between the two groups for the notch width index (OR = 0.7; p = n.s.) and the 'α angle' (OR 1.02; p = n.s.). Significant association between NWI and stenotic notch was found (p < 0.01).
This study showed that Type A stenotic femoral notch can be considered as a valuable predictive factor for ACL injury. Notch width index and 'α angle' are weak indicators in ACL injury prognosis. Ligament impingement may be inferred as an important mechanism in female ACL rupture. Injury prevention strategies, such as prehabilitation programmes, could be introduced in the benefit of young females with stenotic notch.
III.
本文的主要目的是确定女性前交叉韧带（ACL）未受伤与 ACL 受伤患者的股骨切迹形态是否不同。使用磁共振成像（MRI）评估女性患者的股骨切迹类型、切迹宽度指数和“α角”，并测量这些差异。
这是一项回顾性病例对照研究，共纳入 119 名女性患者，58 名 ACL 损伤患者和 61 名 ACL 未损伤患者，均于 2014 年 3 月至 2016 年 4 月接受膝关节 MRI 检查。形态测量由两名独立观察者进行。股骨切迹宽度指数定义为中央切迹宽度与髁间或髁间宽度的比值；比值>0.27 被认为是正常的。股骨切迹形状分为 A 型、U 型或 W 型，其中 A 型描述为狭窄切迹，U 型描述为切迹轮廓较宽，W 型描述为较宽的 U 型并有两个明显的顶点。股骨长轴与 Blumensaat 线之间的夹角定义为“α角”。采用 t 检验、简单和多变量逻辑回归分析进行统计学分析，以评估这些特定股骨切迹形态测量值作为 ACL 撕裂的预测因素的强度。
狭窄的股骨切迹 A 型被确定为 ACL 损伤的高危险因素（比值比 [OR] = 2.8；p = 0.03）。两组间切迹宽度指数（OR = 0.7；p = n.s.）和“α角”（OR 1.02；p = n.s.）无显著差异。NWI 与狭窄切迹之间存在显著相关性（p < 0.01）。
本研究表明，A型狭窄股骨切迹可作为 ACL 损伤的有价值的预测因素。切迹宽度指数和“α角”是 ACL 损伤预后的弱指标。韧带撞击可能是女性 ACL 撕裂的重要机制。可以引入损伤预防策略，如康复前计划，以造福于有狭窄切迹的年轻女性。
III 级。
