Faculty of Medicine, Research Centre for Movement Sciences, The University of Iceland, Sæmundargata 2, 102, Reykjavík, Iceland.
Department of Orthopaedic Surgery, University of Akureyri, Akureyri, Iceland.
Knee Surg Sports Traumatol Arthrosc. 2021 Aug;29(8):2701-2708. doi: 10.1007/s00167-021-06538-3. Epub 2021 Mar 27.
Anterior cruciate ligament (ACL) tears have a major impact on the individual and society. Long term effects may be mediated by injuries that occur concurrently to the ACL tear. The purpose of this study was to describe in a nationwide cohort the traumatic meniscal injuries and bone marrow lesions concomitant to ACL tears, their age and sex distribution and the rate any association with ACL reconstruction.
All ACL tears in Iceland from 2006 to 2011 and their concomitant bone marrow lesions and meniscal injuries were identified from MRI reports. These injuries were further classified by location, sex and age. The cohort was divided into under 17, 17-29, 30-49 and above 50 to reflect likely differences in the mechanisms of injury and risk factors that may vary with age. Data from the Icelandic Social Insurance Administration were used identify all those who were operated. Descriptive analysis was performed to show the proportion of ACL injured knees sustaining concomitant injuries and how these injuries varied with age, sex, and subsequent treatment RESULTS: 1365 knees with ACL ruptures were included. Only 13% of knees had no concomitant injury identified. Overall, 57% of knees had a bone marrow lesion in at least one location and 70% of knees had at least one traumatic meniscal injury. A greater number of combined lateral tibial and femoral bone marrow lesion was seen in younger age groups (χ (3) = 113.32, p < 0.0001). Bruises in the medial compartment were the least common concomitant injuries. More injuries were related to higher chances of ACL reconstruction (OR 1.6, 95% CI 1.4-1.7). Age was associated with risk of all injury types and locations with older age generally being associated with fewer injuries.
In an ACL ruptured cohort, the overall incidence of BMLs may be lower and meniscus injuries higher than previously reported. However, these injuries are more prevalent in the younger cohort potentially resulting in a poorer long-term prognosis. Knowledge of the association between age and concomitant injuries will help guide rehabilitation.
II.
前交叉韧带（ACL）撕裂对个人和社会都有重大影响。长期影响可能是由 ACL 撕裂时同时发生的损伤介导的。本研究的目的是在全国范围内描述 ACL 撕裂时伴发的创伤性半月板损伤和骨髓病变，描述它们的年龄和性别分布，以及与 ACL 重建相关的发生率。
从 2006 年至 2011 年的 MRI 报告中确定冰岛所有 ACL 撕裂及其伴发的骨髓病变和半月板损伤。这些损伤根据位置、性别和年龄进一步分类。该队列分为 17 岁以下、17-29 岁、30-49 岁和 50 岁以上，以反映受伤机制和可能随年龄变化的危险因素的可能差异。使用冰岛社会保险管理局的数据来识别所有接受手术的人。进行描述性分析以显示 ACL 受伤膝关节伴发损伤的比例以及这些损伤如何随年龄、性别和后续治疗而变化。
共纳入 1365 例 ACL 断裂膝关节。只有 13%的膝关节未发现伴发损伤。总体而言，57%的膝关节在至少一个部位存在骨髓病变，70%的膝关节存在至少一处创伤性半月板损伤。在年龄较小的组中，更常见的是外侧胫骨和股骨骨髓病变（χ(3)=113.32，p<0.0001）。内侧半月板损伤是最不常见的伴发损伤。更多的损伤与更高的 ACL 重建几率相关（OR 1.6，95%CI 1.4-1.7）。年龄与所有损伤类型和部位的风险相关，年龄越大，损伤越少。
在 ACL 撕裂队列中，BML 的总体发生率可能低于先前报道，而半月板损伤的发生率可能高于先前报道。然而，这些损伤在年轻组中更为普遍，可能导致预后较差。了解年龄与伴发损伤之间的关系将有助于指导康复。
II 级。
