胫骨后外侧倾斜陡峭、外侧间室骨挫伤和合并内侧副韧带损伤与外侧半月板撕裂的风险增加相关。
Steep posterior lateral tibial slope, bone contusion on lateral compartments and combined medial collateral ligament injury are associated with the increased risk of lateral meniscal tear.
机构信息
Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang Univ., Namyangju-Si, Kyunggi-Do, Korea.
Department of Orthopedic Surgery, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, Korea.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2022 Jan;30(1):298-308. doi: 10.1007/s00167-021-06504-z. Epub 2021 Mar 9.
PURPOSE
To determine the risk factors for lateral meniscus and root tears in patients with acute anterior cruciate ligament (ACL) injuries.
METHODS
A total of 226 patients undergoing acute ACL reconstruction were included in the study sample. Exclusion criteria were revisions, fractures, chronic cases, and multiple ligament injuries, with the exception of medial collateral ligament (MCL) injuries. The patients were divided into groups based on the presence of lateral meniscus and root tears by arthroscopy. Binary logistic regression was used to analyze risk factors including age, sex, body mass index (BMI), injury mechanism (contact/non-contact), Segond fracture, side-to-side laxity, location of bone contusion, medial and lateral tibial and meniscal slope, mechanical axis angle, and grade of pivot shift.
RESULTS
Overall lateral meniscus (LM) tears were identified in 97 patients (42.9%), and LM root tears were found in 22 patients (9.7%). The risk of an LM tear in ACL-injured knees increased with bone contusion on LTP (odds ratio [OR], 3.5; 95% confidence interval [CI] 1.419-8.634; P = 0.007), steeper lateral tibial slope (OR, 1.133; 95% CI 1.003-1.28; P = 0.045), MCL injury (OR, 2.618; 95% CI 1.444-4.746; P = 0.002), and non-contact injury mechanism (OR, 3.132; 95% CI 1.446-6.785; P = 0.004) in logistic regression analysis. The risk of LM root tear in ACL-injured knees increased with high-grade pivot shift (OR, 9.127; 95% CI 2.821-29.525; P = 0.000) and steeper lateral tibial slope (OR, 1.293; 95% CI 1.061-1.576; P = 0.011).
CONCLUSION
The increased risk of LM lesions in acute ACL-injured knees should be considered if significant risk factors including bone contusion on lateral compartments, MCL injury, and a steeper lateral tibial slope are present. Moreover, high-grade rotational injury with steeper lateral tibial slope are also significant risk factors for LM root tears, and therefore care should be taken by clinicians not to miss such lesions.
LEVEL OF EVIDENCE
III.
目的
确定急性前交叉韧带（ACL）损伤患者中外侧半月板和根部撕裂的危险因素。
方法
本研究纳入了 226 例接受急性 ACL 重建的患者。排除标准为翻修、骨折、慢性病例和除内侧副韧带（MCL）损伤外的多韧带损伤。根据关节镜下外侧半月板和根部撕裂的存在情况，将患者分为两组。采用二元逻辑回归分析年龄、性别、体重指数（BMI）、损伤机制（接触/非接触）、Segond 骨折、侧方松弛、骨挫伤部位、胫骨和半月板内外侧斜率、机械轴角度和髌股关节旋转不稳定（Pivot Shift）程度等危险因素。
结果
共有 97 例（42.9%）患者存在外侧半月板（LM）撕裂，22 例（9.7%）患者存在 LM 根部撕裂。ACL 损伤膝关节 LM 撕裂的风险随着外侧间室骨挫伤（优势比[OR]，3.5；95%置信区间[CI] 1.419-8.634；P=0.007）、外侧胫骨斜率变陡（OR，1.133；95% CI 1.003-1.28；P=0.045）、MCL 损伤（OR，2.618；95% CI 1.444-4.746；P=0.002）和非接触损伤机制（OR，3.132；95% CI 1.446-6.785；P=0.004）而增加。在逻辑回归分析中，ACL 损伤膝关节 LM 根部撕裂的风险随着高等级髌股关节旋转不稳定（OR，9.127；95% CI 2.821-29.525；P=0.000）和外侧胫骨斜率变陡（OR，1.293；95% CI 1.061-1.576；P=0.011）而增加。
结论
如果存在外侧间室骨挫伤、MCL 损伤和外侧胫骨斜率变陡等显著危险因素，应考虑急性 ACL 损伤膝关节中 LM 病变的风险增加。此外，高等级旋转损伤伴外侧胫骨斜率变陡也是 LM 根部撕裂的显著危险因素，因此临床医生应注意不要漏诊此类损伤。
证据水平
III 级。
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