Zikria Bashir, Johnson Alex, Hafezi-Nejad Nima, Siddiqui Yalda, Kwee Robert M, Ahlawat Shivani, Morelli John N, Fayad Laura M, Kompel Andrew J, Haj-Mirzaian Arya, Pishgar Farhad, Demehri Shadpour
Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.
Orthop J Sports Med. 2020 Nov 6;8(11):2325967120962804. doi: 10.1177/2325967120962804. eCollection 2020 Nov.
The cause of mucoid degeneration (MD) of the anterior cruciate ligament (ACL), which is commonly observed on magnetic resonance imaging (MRI) of patients with knee pain, has yet to be elucidated. Despite the limited evidence on the relationship between ACL lesions (injury and MD) and tibial morphologic features (ie, posterior tibial slope), the potential association between the presence of ACL MD and medial and lateral tibial slope (MTS and LTS) has not been well-established.
To investigate whether MTS and LTS measurements are associated with the presence of ACL MD.
Cross-sectional study; Level of evidence, 3.
Consecutive knee MRI examinations of patients referred by an orthopaedic surgeon for potential internal joint derangements were identified within a 4-year period. The presence of ACL MD and the MTS/LTS values were assessed by independent expert observers in consensus in a blinded fashion. From 413 consecutive knee MRI scans, a sample of 80 knees, including 32 knees with ACL MD (cases) and 48 knees with normal ACL (controls), were selected using propensity score matching method for age, sex, body mass index, and presence of severe medial tibiofemoral compartment cartilage damage. The association between ACL MD and MTS/LTS was evaluated using conditional regression models.
Knees with ACL MD had higher values of LTS (mean ± SD, 7.18° ± 3.58°) in comparison with control knees (5.32° ± 3.35°). Conditional regression analysis revealed a significant association between LTS measurements (not MTS) and ACL MD; every 1° increase in LTS was associated with a 17% (95% CI, 1%-35%) higher probability of having ACL MD.
Excessive LTS was associated with the presence of ACL MD, independent of participants' age, sex, BMI, and cartilage damage severity.
前交叉韧带（ACL）黏液样变性（MD）在膝关节疼痛患者的磁共振成像（MRI）中较为常见，但其病因尚未阐明。尽管关于ACL损伤（包括损伤和MD）与胫骨形态特征（即胫骨后倾）之间关系的证据有限，但ACL MD与胫骨内、外侧斜率（MTS和LTS）之间的潜在关联尚未得到充分证实。
研究MTS和LTS测量值是否与ACL MD的存在相关。
横断面研究；证据等级，3级。
在4年期间内，对骨科医生转诊的可能存在关节内紊乱的患者进行连续膝关节MRI检查。由独立的专家观察者以盲法达成共识，评估ACL MD的存在情况以及MTS/LTS值。从413例连续膝关节MRI扫描中，采用倾向评分匹配法，根据年龄、性别、体重指数以及是否存在严重的胫股内侧间室软骨损伤，选取了80个膝关节样本，其中包括32个患有ACL MD的膝关节（病例组）和48个ACL正常的膝关节（对照组）。使用条件回归模型评估ACL MD与MTS/LTS之间的关联。
与对照组膝关节（5.32°±3.35°）相比，患有ACL MD的膝关节LTS值更高（平均值±标准差，7.18°±3.58°）。条件回归分析显示，LTS测量值（而非MTS）与ACL MD之间存在显著关联；LTS每增加1°，患ACL MD的概率就会增加17%（95%CI，1%-35%）。
LTS过大与ACL MD的存在相关，且独立于参与者的年龄、性别、体重指数和软骨损伤严重程度。
