异常胫骨对线是前交叉韧带断裂患者外侧半月板后根撕裂的一个危险因素。
Abnormal tibial alignment is a risk factor for lateral meniscus posterior root tears in patients with anterior cruciate ligament ruptures.
机构信息
Department of Orthopaedic Surgery, Henry Ford Health System, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA.
Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2019 Feb;27(2):590-595. doi: 10.1007/s00167-018-5171-4. Epub 2018 Oct 4.
PURPOSE
The purpose of this study was to identify if abnormal tibial alignment was a risk factor for lateral meniscus posterior root tears (LMPRT) in patients with acute anterior cruciate ligament (ACL) ruptures.
METHODS
The medical charts of 200 patients treated for ACL ruptures between 2013 and 2016 were retrospectively reviewed and evaluated. MRI images and reports were assessed for concurrent meniscal tears. Radiographs were reviewed for tibia vara and tibial slope angles and MRI reports identifying lateral root tears were compared to intraoperative reports to determine accuracy. Multiple logistic regression models were constructed to identify potential risk factors for LMPRTs.
RESULTS
Of the 200 patients reviewed, a total of 97 individuals with concurrent meniscal injuries were identified. In patients sustaining a concurrent meniscal injury, there was a 4% incidence of medial meniscus posterior root tears and a 10.3% incidence of LMPRTs. Patients sustaining an ACL injury with an LMPRT were found to have greater tibia vara angles (4.2 ± 1.0 vs. 2.9 ± 1.7; p = 0.024), increased tibial slopes (12.6 ± 1.5 vs. 10.7 ± 2.9; p = 0.034), and higher BMIs (27.3 ± 2.9 vs. 25.3 ± 5.9; p = 0.034) when compared to patients without meniscus tears. There was low agreement between MRI and arthroscopic findings (kappa rate = 0.54). Multiple logistic regression analysis demonstrated that a tibia vara angle > 3 was associated with a 5.2-fold increase (95% CI 0.99-27.01; p = 0.050), and a tibial slope > 12 with a 5.4-fold increase (95% CI 1.03-28.19; p = 0.046) in LMPRTs.
CONCLUSIONS
Patients with greater tibia varus angles, increased tibial slopes, and higher BMIs were found to have an increased risk of LMPRTs when sustaining an ACL rupture. There was a low rate of agreement between MRI and arthroscopy in identifying LMPRTs. In patients with ACL ruptures who have abnormal tibial alignment or increased BMI, physicians should be watchful for lateral meniscus posterior root tears.
LEVEL OF EVIDENCE
目的
本研究旨在确定胫骨对线异常是否是伴有急性前交叉韧带（ACL）撕裂的患者发生外侧半月板后根部撕裂（LMPRT）的危险因素。
方法
回顾性分析 2013 年至 2016 年间接受 ACL 撕裂治疗的 200 例患者的病历，并进行评估。评估 MRI 图像和报告以确定是否存在并发半月板撕裂。评估 X 线片以确定是否存在胫骨内翻和胫骨倾斜角，并比较 MRI 报告中确定的外侧根部撕裂与术中报告以确定准确性。构建多元逻辑回归模型以确定 LMPRT 的潜在危险因素。
结果
在 200 例患者中，共发现 97 例伴有并发半月板损伤的患者。在发生并发半月板损伤的患者中，内侧半月板后根部撕裂的发生率为 4%，外侧半月板后根部撕裂的发生率为 10.3%。发生 ACL 损伤合并 LMPRT 的患者胫骨内翻角度更大（4.2±1.0 比 2.9±1.7；p=0.024），胫骨倾斜度更大（12.6±1.5 比 10.7±2.9；p=0.034），BMI 更高（27.3±2.9 比 25.3±5.9；p=0.034）。与无半月板撕裂的患者相比，MRI 和关节镜检查结果之间的一致性较低（kappa 率=0.54）。多元逻辑回归分析表明，胫骨内翻角度>3 与 5.2 倍的增加相关（95%CI 0.99-27.01；p=0.050），胫骨倾斜度>12 与 5.4 倍的增加相关（95%CI 1.03-28.19；p=0.046）。
结论
在发生 ACL 撕裂的患者中，胫骨内翻角度较大、胫骨倾斜度增加和 BMI 较高的患者发生 LMPRT 的风险增加。MRI 和关节镜检查在识别 LMPRT 方面的一致性较低。对于 ACL 撕裂的患者，如果存在胫骨对线异常或 BMI 增加，医生应密切注意外侧半月板后根部撕裂。
证据水平
3 级。
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