Medical Imaging Department, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.
Medical Imaging Department, Yunnan Cancer Hospital &, The Third Affiliated Hospital of Kunming Medical University, Kunming, China.
BMC Musculoskelet Disord. 2021 Jul 30;22(1):649. doi: 10.1186/s12891-021-04507-y.
At present, the most effective and mature treatment after ACL injury and tear is ACL reconstruction, but the rehabilitation process after ACL reconstruction that is very long, so it is very important to find early MRI positive findings of knee instability.
We retrospectively collected the clinical and imaging data of 70 patients who underwent ACL reconstruction from January 2016 to December 2019; Based on clinical criteria, the patients were divided into a stable group (n = 57) and an unstable group (n = 13); We measured the MRI imaging evaluation indexes, including the position of the bone tunnel, graft status, and the anatomical factors; Statistical methods were used to compare the differences of imaging evaluation indexes between the two groups; The prediction equation was constructed and ROC curve was used to compare the prediction efficiency of independent prediction factors and prediction equation.
There were significant differences in the abnormal position of tibial tunnel entrance, percentage of the position of tibial tunnel entrance, position of tibial tunnel exit, lateral tibial posterior slope (LTPS), width of intercondylar notch between stable knee joint group and unstable knee joint group after ACL reconstruction (P < 0.05); The position of tibial tunnel exits and the lateral tibial posterior slope (LTPS) and the sagittal obliquity of the graft were independent predictors among surgical factors and self-anatomical factors (P < 0.05); The prediction equation of postoperative knee stability was established: Logit(P) = -1.067-0.231position of tibial tunnel exit + 0.509lateral tibial posterior slope (LTPS)-2.105*sagittal obliquity of the graft; The prediction equation predicted that the AUC of knee instability was 0.915, the sensitivity was 84.6%, and the specificity was 91.2%.
We found that abnormalities of the position of the exit of the bone tunnel, lateral tibial posterior slope (LTPS) and sagittal obliquity of the graft were the early MRI positive findings of knee instability after ACL reconstruction. It is helpful for clinicians to predict the stability of knee joint after ACL reconstruction.
目前，ACL 损伤和撕裂后最有效和成熟的治疗方法是 ACL 重建，但 ACL 重建后的康复过程非常漫长，因此找到膝关节不稳定的早期 MRI 阳性发现非常重要。
我们回顾性收集了 2016 年 1 月至 2019 年 12 月期间接受 ACL 重建的 70 例患者的临床和影像学资料；根据临床标准，将患者分为稳定组（n=57）和不稳定组（n=13）；我们测量了 MRI 影像学评估指标，包括骨隧道的位置、移植物的状态和解剖学因素；采用统计学方法比较两组影像学评估指标的差异；构建预测方程，采用 ROC 曲线比较独立预测因素和预测方程的预测效率。
ACL 重建后稳定膝关节组和不稳定膝关节组之间，胫骨隧道入口异常位置、胫骨隧道入口百分比、胫骨隧道出口位置、外侧胫骨后斜率（LTPS）、髁间切迹宽度存在显著差异（P<0.05）；手术因素和自身解剖学因素中，胫骨隧道出口位置、外侧胫骨后斜率（LTPS）和移植物矢状倾斜度是独立预测因素（P<0.05）；建立术后膝关节稳定性预测方程：Logit（P）=-1.067-0.231胫骨隧道出口位置+0.509外侧胫骨后斜率（LTPS）-2.105*移植物矢状倾斜度；预测方程预测膝关节不稳定的 AUC 为 0.915，灵敏度为 84.6%，特异性为 91.2%。
我们发现，骨隧道出口位置、外侧胫骨后斜率（LTPS）和移植物矢状倾斜度异常是 ACL 重建后膝关节不稳定的早期 MRI 阳性发现，有助于临床医生预测 ACL 重建后膝关节的稳定性。
