Department of Diagnostic Radiology, Universidade Federal de São Paulo (UNIFESP-EPM), Rua Napoleão de Barros, 800. Vila Clementino, São Paulo, SP, 04024-002, Brazil.
Diagnósticos da América (DASA), São Paulo, Brazil.
Knee Surg Sports Traumatol Arthrosc. 2019 Oct;27(10):3354-3363. doi: 10.1007/s00167-019-05349-x. Epub 2019 Jan 22.
The aim of this study was to retrospectively compile normative data on the anterior cruciate ligament (ACL) in the paediatric population with magnetic resonance imaging, emphasizing the differences between men and women.
In this retrospective study, musculoskeletal radiologists evaluated length, area, coronal and sagittal inclination of the ACL and inclination of the intercondylar notch. A total of 253 MR examinations (130 males and 123 females between 6 and 18 years of age) were included. The association between measurements, sex and age was considered. Linear and fractional polynomial regression models were used to evaluate the relationships between measurements.
ACL length showed significant progressive growth (p < 0.001) with age in men and women, without characterization of growth peaks. ACL area in women showed more pronounced growth up to 11 years, stabilized from 11 to 14 years and then sustained a slight reduction. In men, ACL area showed more pronounced growth up to 12 years, stabilized from 12 to 15 years and then sustained slight reduction. Coronal and sagittal inclination of the ACL showed a significant progressive increase (p < 0.001) with age in both sexes, progressively verticalizing. The intercondylar roof inclination angle showed significant progressive reduction (p < 0.001) with age in both sexes.
The area of the ACL does not accompany skeletal maturation, interrupting its growth around 11-12 years. Progressive verticalization of the ACL as well as of the intercondylar notch roof in the evaluated ages was also observed. The clinical relevance of this study is that the ACL presents different angular and morphologic changes during growth in the paediatric population. Since ACL repair is now being performed on younger children, recognition of the normal developmental changes of the ACL is of utmost importance for successful ACL graft placement.
III.
本研究旨在通过磁共振成像（MRI）回顾性地汇编儿童前交叉韧带（ACL）的正常数据，重点关注男女之间的差异。
在这项回顾性研究中，肌肉骨骼放射科医生评估了 ACL 的长度、面积、冠状和矢状倾斜以及髁间窝的倾斜。共纳入 253 例 MRI 检查（6-18 岁，男性 130 例，女性 123 例）。考虑了测量值、性别和年龄之间的关系。线性和分数多项式回归模型用于评估测量值之间的关系。
ACL 长度在男性和女性中均随年龄显著增长（p<0.001），没有生长高峰的特征。女性的 ACL 面积在 11 岁之前增长更为明显，11-14 岁之间稳定，然后略有减少。在男性中，ACL 面积在 12 岁之前增长更为明显，12-15 岁之间稳定，然后略有减少。男女两性的 ACL 冠状和矢状倾斜均随年龄显著增加（p<0.001），逐渐变得垂直。髁间窝顶倾斜角在男女两性中均随年龄显著减小（p<0.001）。
ACL 的面积不伴随骨骼成熟，在 11-12 岁左右中断其生长。在评估的年龄中，ACL 以及髁间窝顶逐渐变得垂直。本研究的临床意义在于，ACL 在儿童生长过程中呈现出不同的角度和形态变化。由于现在对年幼的儿童进行 ACL 修复，因此认识 ACL 的正常发育变化对于成功放置 ACL 移植物至关重要。
III 级。
