Campbell Clinic Orthopaedics, University of Tennessee Health Science Center, Memphis, TN, USA.
Twin Cities Orthopedics, 4010 West 65th Street, Edina, MN, 55435, USA.
Knee Surg Sports Traumatol Arthrosc. 2021 Nov;29(11):3883-3891. doi: 10.1007/s00167-021-06456-4. Epub 2021 Feb 1.
While the association with acute anterior cruciate ligament (ACL) tears has been established, other risk factors and associated pathologies which occur with a concomitant lateral meniscal posterior root tear (LMPRT) are not well defined. The purpose of this study was to compare the risk factors and concomitant pathologies between patients with LMPRT and patients without LMPRTs in the setting of a primary ACL tear.
Patients with a LMPRT identified at the time of primary ACL reconstruction by a single surgeon were identified. These patients were matched by age and sex to patients undergoing primary ACL reconstruction who were not found to have lateral meniscus root tears (control group) in a 1:1 ratio. Lateral posterior tibial slope (PTS), medial PTS, lateral femoral condyle height and depth, lateral tibial plateau depth, and lateral tibial plateau subluxation were measured on MRI. Anteroposterior full-limb alignment radiographs were used to measure the medial proximal tibia angle (MPTA), the mechanical lateral distal femoral angle (mLDFA), and the mechanical weightbearing axis for the injured extremity.
One-hundred three patients were included in both the LMPRT group and the matched control group. Patients with a LMPRT had a significantly steeper lateral PTS (9.1° vs. 7.0°, p = 0.001), a steeper medial PTS (7.0° vs. 6.0°, p = 0.03), and a greater lateral-to-medial slope asymmetry (2.0° vs. 1.0°, p = 0.001). There were no differences in lateral femoral condyle depth or height, lateral tibial plateau depth, lateral tibial plateau subluxation, MPTA, mLDFA, or mechanical weightbearing axis between groups. There was a significantly increased incidence of medial meniscus ramp lesions in patients with lateral meniscus posterior root tears compared with controls (34.0% vs. 15.5%, odds ratio: 2.8, p = 0.002). There were no associations with concomitant ligament injuries, medial meniscus root tears, or non-ramp tears based on case/control grouping.
In conclusion, LMPRTs in the setting of primary ACL injuries were associated with significantly increased lateral and medial PTSs, and increased asymmetry between lateral and medial PTSs. In addition, clinicians should be aware of the increased incidence of concurrent medial meniscal ramp lesions in patients with LMPRTs. Knowledge of these associations helps guide clinical decision-making and counselling of patients in the setting of ACL tears with concomitant LMPRTs.
IV.
虽然已经确定了与急性前交叉韧带（ACL）撕裂的关联，但与同时发生的外侧半月板后根撕裂（LMPRT）相关的其他风险因素和相关病理学尚不清楚。本研究的目的是比较初次 ACL 撕裂患者中伴有 LMPRT 患者和不伴有 LMPRT 患者的风险因素和伴随病理学。
通过一位外科医生在初次 ACL 重建时确定存在 LMPRT 的患者。这些患者按年龄和性别与接受初次 ACL 重建且未发现外侧半月板根撕裂（对照组）的患者进行 1:1 配对。在 MRI 上测量外侧后胫骨斜率（PTS）、内侧 PTS、外侧股骨髁高度和深度、外侧胫骨平台深度和外侧胫骨平台半脱位。使用前后全长下肢对线放射照片测量内侧近端胫骨角（MPTA）、机械外侧远端股骨角（mLDFA）和受伤肢体的机械承重轴。
共有 103 例患者同时纳入 LMPRT 组和匹配的对照组。伴有 LMPRT 的患者的外侧 PTS 明显更陡（9.1° vs. 7.0°，p=0.001），内侧 PTS 更陡（7.0° vs. 6.0°，p=0.03），并且外侧到内侧斜率不对称程度更大（2.0° vs. 1.0°，p=0.001）。两组之间的外侧股骨髁深度或高度、外侧胫骨平台深度、外侧胫骨平台半脱位、MPTA、mLDFA 或机械承重轴无差异。与对照组相比，伴有外侧半月板后根撕裂的患者中内侧半月板斜坡病变的发生率明显增加（34.0% vs. 15.5%，优势比：2.8，p=0.002）。根据病例/对照分组，与同时发生的韧带损伤、内侧半月板根撕裂或非斜坡撕裂没有关联。
总之，初次 ACL 损伤时伴有 LMPRT 与明显增加的外侧和内侧 PTS 以及外侧和内侧 PTS 之间的增加不对称有关。此外，临床医生应注意到伴有 LMPRT 的患者并发内侧半月板斜坡病变的发生率增加。这些关联的知识有助于指导 ACL 撕裂伴同时发生的 LMPRT 患者的临床决策和咨询。
IV。
