AZBSC Orthopedics, Scottsdale, Arizona, USA.
School of Science & Technology, Nottingham Trent University, Clifton Campus, Nottingham, UK.
Am J Sports Med. 2021 Jul;49(8):2125-2135. doi: 10.1177/03635465211013015. Epub 2021 May 20.
Recent imaging studies demonstrate that the anterolateral ligament (ALL) is frequently injured at the time of anterior cruciate ligament (ACL) rupture. The intrinsic healing potential of these injuries after ACL reconstruction (ACLR) has not been defined.
PURPOSE/HYPOTHESIS: The primary objective was to evaluate the rate and duration of the healing process of injured ALLs after ACLR using serial 3-dimensional magnetic resonance imaging (3D-MRI). The secondary objective was to investigate whether any patient, injury, or surgical factors influenced the healing rate. The hypothesis was that serial imaging would demonstrate that the ALL has limited healing potential.
Case series; Level of evidence, 4.
Patients enrolled in the study underwent 3D-MRI (slice thickness 0.5 mm) preoperatively and at 1, 6, 12, and 24 months after ACLR. Three observers determined the grade of ALL injury according to the Muramatsu classification. Inter- and intraobserver reliabilities were calculated. The rates of injury and time points for healing were determined. Full healing was defined as a change from a preoperative Muramatsu grade of B or C (indicating partial or complete injury) to grade A (normal). Multivariate analysis was used to investigate the association of aforementioned factors with the risk of incomplete healing.
A total of 44 patients were enrolled in the study. Of them, 71.2% had an ALL injury on preoperative imaging. Overall, full healing of ALL injuries occurred at a rate of 3.2%, 15.2%, and 30.3% at 1, 6, and 12 months, respectively. There were no changes in the Muramatsu grade in any patient beyond 12 months postoperatively. None of the complete lesions demonstrated full healing, but the proportion of patients with a grade C injury decreased from 13.6% preoperatively to 4.5% at 12 months due to an improvement to grade B in 4 of 6 patients (66%). Inter- and intraobserver reliabilities of the classification system were almost perfect at 0.81-0.94 and 0.95-1.00, respectively. None of the potential risk factors investigated were predictive of an increased risk of nonhealing.
ALL injuries occurred in the majority of ACL-injured knees. They had limited intrinsic healing potential, with only 30.3% healing by 12 months after ACLR. The process of healing took >6 months in half of the patients in whom it occurred. No new cases of full healing occurred beyond 12 months postoperatively. No significant risk factors for failure of full healing to occur were identified, but it is likely that this aspect of the study was underpowered.
最近的影像学研究表明，前交叉韧带（ACL）断裂时前外侧韧带（ALL）经常受伤。ACL 重建（ACLR）后这些损伤的内在愈合潜力尚未确定。
目的/假设：主要目的是使用连续的 3 维磁共振成像（3D-MRI）评估 ACLR 后受伤的 ALL 愈合过程的速度和持续时间。次要目的是研究是否有任何患者、损伤或手术因素影响愈合率。假设是连续成像将表明 ALL 具有有限的愈合潜力。
病例系列；证据水平，4 级。
研究中纳入的患者在 ACLR 术前和术后 1、6、12 和 24 个月接受 3D-MRI（层厚 0.5 毫米）。三位观察者根据 Muramatsu 分类法确定 ALL 损伤的程度。计算了观察者间和观察者内的可靠性。确定了损伤的发生率和愈合的时间点。完全愈合定义为术前 Muramatsu 分级 B 或 C（表示部分或完全损伤）变为 A 级（正常）的变化。使用多变量分析调查上述因素与不完全愈合风险的关联。
共有 44 名患者入组。其中，71.2%的患者术前影像学检查存在 ALL 损伤。总体而言，ALL 损伤的完全愈合率分别为 3.2%、15.2%和 30.3%，分别在术后 1、6 和 12 个月。术后任何患者的 Muramatsu 分级均无变化。没有完全病变的患者完全愈合，但由于 6 例中有 4 例（66%）改善为 B 级，术前 C 级损伤的患者比例从 13.6%降至 12 个月时的 4.5%。分类系统的观察者间和观察者内可靠性分别为 0.81-0.94 和 0.95-1.00，几乎完美。未发现任何研究的潜在危险因素可预测愈合不良的风险增加。
ACL 损伤的膝关节中，大多数都存在 ALL 损伤。它们具有有限的内在愈合潜力，只有 30.3%在 ACLR 后 12 个月内愈合。在发生 ALL 损伤的患者中，有一半的愈合过程需要 >6 个月。术后 12 个月后未出现新的完全愈合病例。未发现完全愈合失败的显著危险因素，但很可能本研究的这一方面存在效力不足。
