1st Department of Orthopaedics, ATTIKO University Hospital, National and Kapodistrian University of Athens, Rimini 1, Haidari, 12462, Athens, Greece.
Orthopaedic Research and Education Center P.N.Soukakos, Biomechanics and Gait Analysis Laboratory, 1st Department of Orthopaedics, Medical School, ATTIKO University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Knee Surg Sports Traumatol Arthrosc. 2022 Mar;30(3):842-851. doi: 10.1007/s00167-020-06387-6. Epub 2021 Feb 2.
The purpose of this study is to examine the association between the development of articular cartilage pathology and knee rotation after single-bundle anterior cruciate ligament (ACL) reconstruction.
Seventeen patients that underwent single-bundle ACL reconstruction and did not have any cartilage lesions at the time of surgery based on the Outerbridge classification or meniscal injury that required meniscectomy > 20% were examined by MRI and in the biomechanics laboratory at a 6-year minimum follow-up. Cartilage lesions that occurred after reconstruction were graded on MRI according to a modified Noyes scale. For cartilage evaluation, the lateral and medial femoral condyles were divided into 9 segments each (lateral, central, and medial third and each third was divided into anterior, central, and posterior segment). Tibial rotation during a pivoting task was measured with optoelectronic motion analysis system and side-to-side differences of tibial rotation between the reconstructed and contralateral intact knees were calculated. The association between the total modified Noyes scale score (outcome variable) and side-to-side differences of tibial rotation after controlling for meniscectomy and meniscal repair was investigated with hierarchical regression models.
Side-to-side difference of tibial rotation was associated with total modified Noyes scale score (p = 0.015, β = 0.667, adjusted R = 42.1%). All patients developed new cartilage lesions in MRI located mainly at the central region of the lateral femoral condyle and less frequently in the central and anterior regions of the medial femoral condyle.
Abnormally increased tibial rotation that persists after ACL-R is significantly associated with the development of new articular cartilage lesions at mean 8.4 years after reconstruction which were located mainly at the central region of the LFC and secondarily in the central and anterior regions of the MFC (more superficial lesions). These findings suggest that there is emerging evidence that abnormal rotational kinematics is a potential risk factor for the pathogenesis and onset of posttraumatic articular cartilage degeneration after ACLR.
IV.
本研究旨在探讨前交叉韧带（ACL）重建后关节软骨病变与膝关节旋转之间的关系。
17 例患者在接受 ACL 重建后进行 MRI 检查和生物力学实验室检查，随访时间至少为 6 年。根据改良的 Noyes 分级标准，对术后发生的软骨损伤进行分级。为了评估软骨，将外侧和内侧股骨髁分为 9 个区域（外侧、中央和内侧三分之一，每个三分之一再分为前、中、后段）。在旋转任务中使用光电运动分析系统测量胫骨旋转，计算重建侧和对侧未受伤膝关节之间胫骨旋转的侧间差异。通过分层回归模型，研究在控制半月板切除术和半月板修复的情况下，总改良 Noyes 分级评分（因变量）与胫骨旋转的侧间差异之间的关系。
胫骨旋转的侧间差异与总改良 Noyes 分级评分相关（p=0.015，β=0.667，调整后的 R²=42.1%）。所有患者在 MRI 上均出现新的软骨损伤，主要位于外侧股骨髁的中央区域，内侧股骨髁的中央和前区域也较少见。
ACL-R 后持续存在的胫骨过度旋转与重建后 8.4 年新的关节软骨损伤显著相关，这些损伤主要位于外侧股骨髁的中央区域，其次是内侧股骨髁的中央和前区域（更浅表的损伤）。这些发现表明，异常的旋转运动学可能是 ACLR 后创伤性关节软骨退变发生和发展的潜在危险因素。
IV 级。
