Kim Seong Hwan, Park Yong-Beom, Won Yoo-Sun
Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea.
Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea.
Arthroscopy. 2021 Oct;37(10):3159-3165. doi: 10.1016/j.arthro.2021.03.078. Epub 2021 Apr 20.
This study aimed to determine radiological findings associated with ramp lesions in knees with anterior cruciate ligament (ACL) injury.
This study included the primary ACL reconstructions from June 2011 to March 2019. The exclusion criteria were combined fractures and multiligament injuries. Patients were categorized based on arthroscopy-confirmed presence of ramp lesions, which was defined as a longitudinal tear around the meniscocapsular junction or red-red zone tear of medial meniscus posterior horn. Binary logistic regression analysis was performed to find the risk factors such as age, sex, body mass index, medial tibial slope, mechanical axis angle, presence of Segond fracture, and lateral femoral condyle (LFC) ratio. Additionally, receiver operating characteristic (ROC) curves and area under the ROC curve (AUC) were evaluated.
Ramp lesions were identified in 89 (27.7%) patients among the total 321 included primary ACL reconstructions. The risk of ramp lesion was associated with increased LFC ratio (odds ratio [OR]: 62.929; 95% confidence interval [CI]: 8.473-467.351; P < .001), varus alignment >3° (OR: 5.858; 95% CI: 3.272-10.486; P < .001), and steeper medial tibial slope (OR: 1.183; 95% CI: 1.05-1.333; P = .006). The cutoff values of the LFC ratio and medial tibial slope for ramp lesions were >71% (AUC: 0.696; sensitivity: 43.82%; specificity: 91.38%; P < .001) and >12.1° (AUC: 0.643; sensitivity: 85.39%; specificity: 38.79%; P < .001), respectively.
Deep posterior LFC, varus alignment, and steep medial tibial slope were associated factors for ramp lesions in knees with ACL injury. In patients with ACL injury who show the above-mentioned radiographic findings, careful assessment and suspicion for ramp lesions should be considered.
Level III, retrospective cross-sectional study.
本研究旨在确定与前交叉韧带（ACL）损伤膝关节斜坡损伤相关的影像学表现。
本研究纳入了2011年6月至2019年3月期间初次进行ACL重建的患者。排除标准为合并骨折和多韧带损伤。根据关节镜检查确诊的斜坡损伤情况对患者进行分类，斜坡损伤定义为半月板-关节囊交界处的纵向撕裂或内侧半月板后角红-红区撕裂。进行二元逻辑回归分析以找出年龄、性别、体重指数、胫骨内侧斜率、机械轴角、Segond骨折的存在以及外侧股骨髁（LFC）比率等危险因素。此外，评估了受试者工作特征（ROC）曲线和ROC曲线下面积（AUC）。
在纳入的321例初次ACL重建患者中，89例（27.7%）发现有斜坡损伤。斜坡损伤的风险与LFC比率增加（比值比[OR]：62.929；95%置信区间[CI]：8.473 - 467.351；P <.001）、内翻对线>3°（OR：5.858；95%CI：3.272 - 10.486；P <.001）以及胫骨内侧斜率更陡（OR：1.183；95%CI：1.05 - 1.333；P =.006）相关。斜坡损伤的LFC比率和胫骨内侧斜率的截断值分别为>71%（AUC：0.696；敏感性：43.82%；特异性：91.38%；P <.001）和>12.1°（AUC：0.643；敏感性：85.39%；特异性：38.79%；P <.001）。
后外侧LFC加深、内翻对线和胫骨内侧斜率陡峭是ACL损伤膝关节斜坡损伤的相关因素。对于出现上述影像学表现的ACL损伤患者，应考虑仔细评估并怀疑存在斜坡损伤。
III级，回顾性横断面研究。
