Houston Methodist Hospital Orthopedics & Sports Medicine, Houston, Texas, U.S.A.
Mayo Clinic, Rochester, Minnesota, U.S.A.
Arthroscopy. 2018 Mar;34(3):943-950. doi: 10.1016/j.arthro.2017.08.302. Epub 2017 Nov 20.
To perform a systematic review to determine if there is (1) an association between decreased hip internal rotation and anterior cruciate ligament (ACL) tear rates; (2) an association between radiographic femoroacetabular impingement (FAI) and ACL tear rates; and (3) biomechanical evidence demonstrating increased strain in the ACL of patients with decreased hip internal rotation.
A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies investigating relationships between hip motion, hip radiographs, and ACL tear were sought. Studies with Levels of evidence I-IV were eligible for inclusion. Study methodology/evidence were evaluated using Methodological Index for Non-Randomized Studies (MINORS), Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.
Eleven studies were analyzed (2 cadaveric in vitro models, 8 clinical studies measuring hip internal rotation (2 concurrently assessing radiographic FAI), and 1 clinical study assessing radiographic FAI alone). Mean MINORS, STROBE, and GRADE for the studies was 82.4%, 20.9 out of 22, and "low," respectively. A total of 959 subjects (84.8% male; mean age 23.6 ± 3.8 years) were analyzed. Overall, 378 subjects sustained 427 ACL tears (399 primary ACL ruptures, 28 reruptures). Six of 8 clinical studies identified a significant association between limited rotation (internal rotation [IR; loss greater than 10°-20°], external rotation [ER], or combined IR + ER [loss greater than 20°]) and ACL tears. Two studies found an association between ACL ruptures and radiographic cam/pincer impingement. Two cadaveric models found a significant association between ACL strain and limited hip internal rotation.
This systematic review identified a significant association between ACL tear and both limited hip rotation and radiographic FAI.
Level IV, systematic review of Levels II-IV studies.
进行系统评价，以确定（1）髋关节内旋减少与前交叉韧带（ACL）撕裂率之间是否存在关联；（2）放射影像学股骨髋臼撞击症（FAI）与 ACL 撕裂率之间是否存在关联；以及（3）生物力学证据是否表明髋关节内旋减少的患者 ACL 受到更大的张力。
使用系统评价和荟萃分析的首选报告项目（PRISMA）指南进行系统评价。研究旨在调查髋关节运动、髋关节 X 线片和 ACL 撕裂之间的关系。纳入了具有证据水平 I-IV 的研究。使用非随机研究方法学指数（MINORS）、观察性研究的强化报告标准（STROBE）和推荐评估、制定与评估分级（GRADE）标准评估研究方法/证据。
分析了 11 项研究（2 项尸体体外模型，8 项临床研究测量髋关节内旋（2 项同时评估放射影像学 FAI），1 项临床研究单独评估放射影像学 FAI）。研究的平均 MINORS、STROBE 和 GRADE 分别为 82.4%、20.9/22 和“低”。共分析了 959 名受试者（84.8%为男性；平均年龄 23.6±3.8 岁）。总体而言，378 名受试者发生 427 例 ACL 撕裂（399 例为原发性 ACL 断裂，28 例为再撕裂）。8 项临床研究中有 6 项确定了旋转受限（内旋[IR；损失大于 10°-20°]、外旋[ER]或联合 IR+ER[损失大于 20°]）与 ACL 撕裂之间存在显著关联。两项研究发现 ACL 撕裂与放射影像学凸轮/钳夹撞击之间存在关联。两项尸体模型研究发现 ACL 应变与髋关节内旋受限之间存在显著关联。
本系统评价确定了 ACL 撕裂与髋关节旋转受限和放射影像学 FAI 之间存在显著关联。
IV 级，对 II-IV 级研究的系统评价。
