Imaging Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Imaging Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Arthroscopy. 2018 Feb;34(2):557-565. doi: 10.1016/j.arthro.2017.08.296. Epub 2017 Dec 6.
To determine if posterior cruciate ligament (PCL) and intercondylar notch (IN) morphometries and volumetrics act as risk factors for anterior cruciate ligament (ACL) tears.
A prospective case-controlled magnetic resonance imaging (MRI) study was conducted with subjects presenting noncontact knee injuries. Exclusion criteria were previous surgery, PCL tear, osteoarthritis, tumors, or infectious and inflammatory conditions. All participants underwent a flexed-knee 3-dimensional (3D) magnetic resonance imaging (MRI) to uniformly straighten PCL. MR images were independently reviewed by 2 radiologists and assessed for 2D and 3D measurements (bicondylar width; IN angle, depth, width, and cross-sectional area; PCL width, thickness, and cross-sectional area; and IN and PCL volumes). Clinical profiles were tabulated and subjects were divided into cases (ACL tear) and controls (without ACL tear).
The study was composed of 50 cases versus 52 controls (N = 102), with a mean age of 36.8 years. There was no difference between groups (P > .05) regarding age, gender, body mass index, time from injury, Tegner score, flexion angle, limb side, intensity of injury, or familial or opposite limb history of tear. Agreement between readers ranged from substantial to almost perfect. Subjects with ACL tear presented with lower IN width, lower IN minus PCL widths, lower Notch Width Index, higher PCL/IN width proportion, higher PCL thickness, lower IN depth minus PCL thickness, and higher PCL thickness/IN depth proportion (P < .05). Moreover, higher PCL/IN cross-sectional area proportion, higher PCL volumes (OR = 9.01), and higher PCL/IN volume proportion were also found in cases.
Our study shows that subjects with ACL tears present not only reduced IN but also larger PCL dimensions. These findings, isolated and combined, and especially PCL volume, might be suggestive as risk factors for ACL tears owing to the reduction of its space inside the IN.
Level III, comparative group.
确定后交叉韧带（PCL）和髁间切迹（IN）形态和体积是否作为前交叉韧带（ACL）撕裂的危险因素。
进行了一项前瞻性病例对照磁共振成像（MRI）研究，纳入了非接触性膝关节损伤的受试者。排除标准为既往手术、PCL 撕裂、骨关节炎、肿瘤或感染性及炎症性疾病。所有参与者均接受了屈膝 3 维（3D）磁共振成像（MRI）检查，以均匀伸直 PCL。由 2 名放射科医生独立对 MRI 图像进行评估，并对 2D 和 3D 测量结果（双髁宽度；IN 角、深度、宽度和横截面积；PCL 宽度、厚度和横截面积；以及 IN 和 PCL 体积）进行评估。记录临床资料，将受试者分为病例组（ACL 撕裂）和对照组（无 ACL 撕裂）。
该研究共纳入 50 例病例和 52 例对照（N=102），平均年龄为 36.8 岁。两组在年龄、性别、体重指数、损伤后时间、Tegner 评分、膝关节屈曲角度、肢体侧别、损伤严重程度、家族史或对侧肢体撕裂史方面无差异（P>.05）。读者间的一致性从高度一致到几乎完美。ACL 撕裂组的 IN 宽度较低，IN 与 PCL 之间的宽度较小，IN 宽度指数较低，PCL/IN 宽度比例较高，PCL 厚度较大，IN 深度与 PCL 厚度之差较小，PCL 厚度/IN 深度比例较高（P<.05）。此外，病例组的 PCL/IN 横截面积比例较高，PCL 体积（比值比=9.01）和 PCL/IN 体积比例也较高。
本研究表明，ACL 撕裂患者不仅 IN 减小，而且 PCL 尺寸增大。这些发现，孤立或联合，特别是 PCL 体积，可能是 ACL 撕裂的危险因素，因为其在 IN 内的空间减小。
III 级，对照研究。
