Levins James G, Argentieri Erin C, Sturnick Daniel R, Gardner-Morse Mack, Vacek Pamela M, Tourville Timothy W, Johnson Robert J, Slauterbeck James R, Beynnon Bruce D
Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA.
Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA.
Am J Sports Med. 2017 Dec;45(14):3223-3232. doi: 10.1177/0363546517735091. Epub 2017 Oct 13.
Contralateral anterior cruciate ligament (CACL) injury after recovery from a first-time ACL rupture occurs at a high rate in young females; however, little is known about the risk factors associated with bilateral ACL trauma.
The geometric characteristics of the contralateral knee at the time of the initial ACL injury are associated with risk of suffering a CACL injury in these female athletes.
Case-control study; Level of evidence, 3.
Sixty-two female athletes who suffered their first noncontact ACL injury while participating in sports at the high school or college level were identified, and geometry of the femoral notch, ACL, tibial spines, tibial subchondral bone, articular cartilage surfaces, and menisci of the contralateral, uninjured, knee was characterized in 3 dimensions. We were unable to contact 7 subjects and followed the remaining 55 until either a CACL injury or an ACL graft injury occurred or, if they were not injured, until the date of last contact (mean, 34 months after their first ACL injury). Cox regression was used to identify risk factors for CACL injury.
Ten (18.2%) females suffered a CACL injury. Decreases of 1 SD in femoral intercondylar notch width (measured at its outlet and anterior attachment of the ACL) were associated with increases in the risk of suffering a CACL injury (hazard ratio = 1.88 and 2.05, respectively). Likewise, 1 SD decreases in medial-lateral width of the lateral tibial spine, height of the medial tibial spine, and thickness of the articular cartilage located at the posterior region of the medial tibial compartment were associated with 3.59-, 1.75-, and 2.15-fold increases in the risk of CACL injury, respectively.
After ACL injury, subsequent injury to the CACL is influenced by geometry of the structures that surround the ACL (the femoral notch and tibial spines). This information can be used to identify individuals at increased risk for CACL trauma, who might benefit from targeted risk-reduction interventions.
年轻女性首次前交叉韧带（ACL）断裂恢复后，对侧前交叉韧带（CACL）损伤发生率较高；然而，关于双侧ACL创伤的危险因素知之甚少。
初次ACL损伤时对侧膝关节的几何特征与这些女性运动员发生CACL损伤的风险相关。
病例对照研究；证据等级，3级。
确定62名在高中或大学水平参加体育活动时首次发生非接触性ACL损伤的女性运动员，并对其对侧未受伤膝关节的股骨髁间窝、ACL、胫骨棘、胫骨软骨下骨、关节软骨表面和半月板的几何形状进行三维特征分析。我们无法联系到7名受试者，对其余55名进行随访，直至发生CACL损伤或ACL移植物损伤，或者，如果她们未受伤，则随访至最后一次接触日期（平均在首次ACL损伤后34个月）。采用Cox回归分析确定CACL损伤的危险因素。
10名（18.2%）女性发生CACL损伤。股骨髁间窝宽度（在其出口和ACL前附着处测量）每降低1个标准差，发生CACL损伤的风险增加（风险比分别为1.88和2.05）。同样，外侧胫骨棘的内外侧宽度、内侧胫骨棘高度以及位于内侧胫股关节后部的关节软骨厚度每降低1个标准差，CACL损伤风险分别增加3.59倍、1.75倍和2.15倍。
ACL损伤后，CACL的后续损伤受ACL周围结构（股骨髁间窝和胫骨棘）几何形状的影响。这些信息可用于识别CACL创伤风险增加的个体，他们可能受益于有针对性的降低风险干预措施。
