基于 MRI 的冠状外侧副韧带征在前交叉韧带重建移植物失败中的预测价值。

Predictive Value of the Magnetic Resonance Imaging-Based Coronal Lateral Collateral Ligament Sign on Adolescent Anterior Cruciate Ligament Reconstruction Graft Failure.

机构信息

Department of Orthopaedic Surgery, University of California-San Diego, San Diego, California, USA.

Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA.

出版信息

Am J Sports Med. 2021 Mar;49(4):935-940. doi: 10.1177/0363546521988939. Epub 2021 Feb 22.

DOI:10.1177/0363546521988939

PMID:33617286

Abstract

BACKGROUND

The coronal lateral collateral ligament (LCL) sign is the presence of the full length of the LCL visualized on a single coronal magnetic resonance imaging (MRI) slice at the posterolateral corner of the knee. The coronal LCL sign has been shown to be associated with elevated measures of anterior tibial translation and internal rotation in the setting of anterior cruciate ligament (ACL) tear.

HYPOTHESIS

The coronal LCL sign (with greater anterior translation, internal rotation, and posterior slope of the tibia) will indicate a greater risk for graft failure after ACL reconstructive surgery.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Retrospective review was performed of adolescent patients with ACL reconstruction: a cohort without graft failure and a cohort with graft failure. MRI was utilized to measure tibial translation and femorotibial rotation and to identify the coronal LCL sign. The posterior tibial slope was measured on lateral radiographs. Patient-reported outcomes were collected.

RESULTS

We identified 114 patients with no graft failure and 39 patients with graft failure who met all criteria, with a mean follow-up time of 3.5 years (range, 2-9.4 years). Anterior tibial translation was associated with anterolateral complex injury ( < .001) but not graft failure ( = .06). Internal tibial rotation was associated with anterolateral complex injury ( < .001) and graft failure ( = .042). Posterior tibial slope was associated with graft failure ( = .044). The coronal LCL sign was associated with anterolateral complex injury ( < .001) and graft failure ( = .013), with an odds ratio of 4.3 for graft failure (95% CI, 1.6-11.6; = .003). Subjective patient-reported outcomes and return to previous level of sport were not associated with failure. Comparison of MRI before and after ACL reconstruction in the graft failure cohort demonstrated a reduced value in internal rotation ( = .003) but no change in coronal LCL sign ( = .922).

CONCLUSION

Our study demonstrates that tibial internal rotation and posterior slope are independent predictors of ACL graft failure in adolescents. Although the value of internal rotation could be improved with ACL reconstruction, the presence of the coronal LCL sign persisted over time and was predictive of graft rupture (without the need to make measurements or memorize values of significant risk). Together, these factors indicate that greater initial knee deformity after initial ACL tear predicts greater risk for future graft failure.

摘要

背景

冠状外侧副韧带（LCL）征是指在膝关节后外侧角的单个冠状磁共振成像（MRI）切片上可见完整长度的 LCL。冠状 LCL 征已被证明与前交叉韧带（ACL）撕裂时胫骨前向平移和内旋的升高测量值相关。

假设

冠状 LCL 征（具有更大的前向平移、内旋和胫骨后倾）将表明 ACL 重建手术后移植物失败的风险更大。

研究设计

队列研究；证据水平，3 级。

方法

对 ACL 重建的青少年患者进行回顾性分析：无移植物失败的队列和有移植物失败的队列。MRI 用于测量胫骨平移和股骨胫骨旋转，并确定冠状 LCL 征。在侧位 X 线片上测量胫骨后倾角。收集患者报告的结果。

结果

我们确定了 114 名无移植物失败和 39 名移植物失败的患者，所有患者均符合所有标准，平均随访时间为 3.5 年（范围，2-9.4 年）。胫骨前向平移与前外侧复合体损伤相关（<0.001），但与移植物失败无关（=0.06）。胫骨内旋与前外侧复合体损伤相关（<0.001），与移植物失败相关（=0.042）。胫骨后倾角与移植物失败相关（=0.044）。冠状 LCL 征与前外侧复合体损伤相关（<0.001），与移植物失败相关（=0.013），移植物失败的优势比为 4.3（95%CI，1.6-11.6；=0.003）。主观患者报告的结果和重返以前的运动水平与失败无关。在移植物失败队列中，比较 ACL 重建前后的 MRI 显示，内旋值降低（=0.003），但冠状 LCL 征无变化（=0.922）。

结论

我们的研究表明，青少年 ACL 移植物失败的独立预测因素是胫骨内旋和后倾。尽管 ACL 重建可以改善内旋值，但冠状 LCL 征的存在随着时间的推移仍然存在，并预测移植物破裂（无需进行测量或记住有显著风险的数值）。这些因素共同表明，初始 ACL 撕裂后更大的初始膝关节畸形预示着未来移植物失败的风险更高。