MRI 检查中 ACL 完全撕裂患者胫骨前被动半脱位的风险因素。
Risk factors for passive anterior tibial subluxation on MRI in complete ACL tear.
机构信息
Université Paris Saclay, AP-HP, 92100 Boulogne-Billancourt, France.
ELSAN, 75008 Paris, France.
出版信息
Orthop Traumatol Surg Res. 2020 May;106(3):465-468. doi: 10.1016/j.otsr.2019.10.025. Epub 2020 Jan 23.
INTRODUCTION
In anterior cruciate ligament (ACL) tear, passive spontaneous anterior tibial subluxation (ATS), with respect to the femur, is sometimes observed on MRI. In a case-control study, ATS>3.5mm showed 100% specificity (±3.6, 95% CI) for complete ACL tear. The aim of the present study was to assess the relation between ATS on MRI and associated lesions in complete ACL tear. The study hypothesis was that associated lesions are a risk factor for ATS.
MATERIAL AND METHODS
A retrospective study included patients operated on for complete ACL tear between 2010 and 2015. Exclusion criteria comprised associated posterior cruciate ligament tear, partial ACL tear, and history of knee surgery. Preoperative MRI was performed with the patient in supine position and the knee in 20° flexion in neutral rotation. ATS was measured by axial superimposition of the bicondylar slice on the slice through the tibial plateau. Associated lesions were assessed: medial and lateral menisci, collateral ligaments, posteromedial and posterolateral corners, tibiofemoral compartment cartilage and cancellous bone. Factors associated with ATS>3.5mm were analyzed. Ninety-one patients were included: mean age, 31.1±10.1 years; 34 female, 57 male. Mean time from injury to MRI was 7.8±11.7 months (range, 0.7-60 months).
RESULTS
Mean ATS was 4.7±2.3mm. Inter- and intra-observer reproducibility for ATS measurement were excellent. On preoperative MRI, 61.1% of patients showed bone edema, 48.4% medial meniscal tear, and 36.3% lateral meniscal tear. ATS was significantly greater in case of medial meniscal tear (5.4±2.3mm vs. 4±2.1mm; p=0.003). No significant differences were found according to other lesions. Fifty-four patients (59.3%) showed ATS>3.5mm; risk factors comprised medial meniscal tear (OR=2.6, 95%CI [1.1-6.2]; p=0.03) and injury-to-MRI time>9 months (OR=9.8, 95% CI [1.1-85.2]; p=0.04).
CONCLUSION
Spontaneous anterior tibial subluxation on MRI in complete ACL tear was significantly associated with medial meniscal tear and accident-to-MRI time.
LEVEL OF EVIDENCE
IV, retrospective cohort study.
介绍
在前交叉韧带（ACL）撕裂中，有时在 MRI 上观察到股骨相对于胫骨的被动自发性前胫骨侧方移位（ATS）。在病例对照研究中，ATS>3.5mm 对完全 ACL 撕裂具有 100%的特异性（±3.6，95%CI）。本研究的目的是评估 MRI 上的 ATS 与完全 ACL 撕裂相关的病变之间的关系。研究假设是相关病变是 ATS 的一个危险因素。
材料和方法
回顾性研究纳入了 2010 年至 2015 年间因完全 ACL 撕裂而接受手术的患者。排除标准包括合并后交叉韧带撕裂、部分 ACL 撕裂和膝关节手术史。术前 MRI 采用仰卧位，膝关节在中立旋转位 20°屈曲下进行。通过轴向叠加双髁切片和胫骨平台切片测量 ATS。评估相关病变：内侧和外侧半月板、侧副韧带、后内侧和后外侧角、胫股关节软骨和松质骨。分析与 ATS>3.5mm 相关的因素。共纳入 91 例患者：平均年龄 31.1±10.1 岁；女性 34 例，男性 57 例。从损伤到 MRI 的平均时间为 7.8±11.7 个月（范围 0.7-60 个月）。
结果
平均 ATS 为 4.7±2.3mm。ATS 测量的组内和组间重复性均很好。术前 MRI 上，61.1%的患者有骨水肿，48.4%的患者有内侧半月板撕裂，36.3%的患者有外侧半月板撕裂。内侧半月板撕裂的 ATS 明显更大（5.4±2.3mm 比 4±2.1mm；p=0.003）。其他病变无显著差异。54 例（59.3%）患者 ATS>3.5mm；危险因素包括内侧半月板撕裂（OR=2.6，95%CI [1.1-6.2]；p=0.03）和损伤至 MRI 时间>9 个月（OR=9.8，95%CI [1.1-85.2]；p=0.04）。
结论
完全 ACL 撕裂 MRI 上的自发性胫骨前侧方移位与内侧半月板撕裂和损伤至 MRI 时间显著相关。
证据水平
IV，回顾性队列研究。
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