与前交叉韧带缺失的膝关节中的深层髂胫束（Kaplan 纤维）损伤相比，磁共振成像显示前外侧韧带损伤更为常见。
Injuries to the anterolateral ligament are observed more frequently compared to lesions to the deep iliotibial tract (Kaplan fibers) in anterior cruciate ligamant deficient knees using magnetic resonance imaging.
机构信息
Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
Department of Radiology, Medical University Innsbruck, Innsbruck, Austria.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2022 Jan;30(1):309-318. doi: 10.1007/s00167-021-06535-6. Epub 2021 Mar 26.
PURPOSE
To determine the accuracy of detection, injury rate and inter- and intrarater reproducibility in visualizing lesions to the anterolateral ligament (ALL) and the deep portion of the iliotibial tract (dITT) in anterior cruciate ligament (ACL) deficient knees.
METHODS
Ninety-one consecutive patients, out of those 25 children (age 14.3 ± 3.5 years), with diagnosed ACL tears were included. Two musculoskeletal radiologists retrospectively reviewed MRI data focusing on accuracy of detection and potential injuries to the ALL or dITT. Lesion were diagnosed in case of discontinued fibers in combination with intra- or peri-ligamentous edema and graded as intact, partial or complete tears. Cohen's Kappa and 95% confidence intervals (95% CI) were determined for inter- and intrarater reliability measures.
RESULTS
The ALL and dITT were visible in 52 (78.8%) and 56 (84.8%) of adult-and 25 (100%) and 19 (76.0%) of pediatric patients, respectively. The ALL was injured in 45 (58.5%; partial: 36.4%, compleate: 22.1%) patients. Partial and comleate tears, where visualized in 21 (40.4%) and 16 (30.8%) adult- and seven (28.0%) and one (4%) peditric patients. A total of 16 (21.3%; partial: 13.3%, compleate: 8.0%) dITT injuries were identified. Partal and complete lesions were seen in seven (12.5%) and five (8.9%) adult- and three (15.8%) and one (5.3%) pediatric patients. Combined injuries were visualized in nine (12.7%) patients. Inter-observer (0.91-0.95) and intra-observer (0.93-0.95) reproducibility was high.
CONCLUSION
In ACL injured knees, tears of the ALL are observed more frequently compared to lesions to the deep iliotibial tract. Combined injuries of both structures are rare. Clinically, the preoperative visualization of potentially injured structures of the anterolateral knee is crucial and is important for a more personalized preoperative planning and tailored anatomical reconstruction. The clinical implication of injuries to the anterolateral complex of the knee needs further investigation.
LEVEL OF EVIDENCE
II.
目的
确定在检测前交叉韧带（ACL）缺失膝关节前外侧韧带（ALL）和阔筋膜张肌深层部分（dITT）损伤中的准确性、损伤率以及观察者间和观察者内的可重复性。
方法
连续纳入 91 例患者，其中 25 例为儿童（年龄 14.3±3.5 岁），均诊断为 ACL 撕裂。2 名肌肉骨骼放射科医生回顾性分析 MRI 数据，重点关注检测的准确性和 ALL 或 dITT 的潜在损伤。如果纤维连续性中断，并伴有韧带内或周围水肿，则诊断为病变，并将其分为完整、部分或完全撕裂。采用 Cohen's Kappa 和 95%置信区间（95%CI）评估观察者间和观察者内的可靠性测量。
结果
52 例（78.8%）成人和 25 例（100%）儿童患者的 ALL 和 56 例（84.8%）成人和 19 例（76.0%）儿童患者的 dITT 可被观察到。45 例（58.5%；部分撕裂：36.4%，完全撕裂：22.1%）患者的 ALL 受伤。21 例（40.4%）成人和 16 例（30.8%）儿童患者的部分和完全撕裂，7 例（28.0%）成人和 1 例（4%）儿童患者的部分和完全撕裂可被观察到。16 例（21.3%；部分撕裂：13.3%，完全撕裂：8.0%）dITT 损伤被识别。7 例（12.5%）成人和 3 例（15.8%）儿童患者的部分和完全损伤，5 例（8.9%）成人和 1 例（5.3%）儿童患者的完全损伤可被观察到。9 例（12.7%）患者的联合损伤可被观察到。观察者间（0.91-0.95）和观察者内（0.93-0.95）的可重复性均较高。
结论
在 ACL 损伤的膝关节中，ALL 的撕裂比 dITT 的损伤更为常见。两种结构的联合损伤较为罕见。在临床上，对前外侧膝关节潜在损伤结构的术前可视化至关重要，这对更个性化的术前规划和定制解剖重建非常重要。膝关节前外侧复合体损伤的临床意义需要进一步研究。
证据等级
II 级。
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