Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Arch Orthop Trauma Surg. 2022 Jul;142(7):1605-1612. doi: 10.1007/s00402-021-04105-6. Epub 2021 Aug 2.
ACL injury is one of the most common injuries of the knee joint in sports. As accompanying osseous injuries of the ACL rupture a femoral impression the so-called lateral femoral notch sign and a posterolateral fracture of the tibial plateau are described. However, frequency, concomitant ligament injuries and when and how to treat these combined injuries are not clear. There is still a lack of understanding with which ligamentous concomitant injuries besides the anterior cruciate ligament injury these bony injuries are associated.
One hundred fifteen MRI scans with proven anterior cruciate ligament rupture performed at our center were retrospectively evaluated for the presence of a meniscus, collateral ligament injury, a femoral impression, or a posterolateral impression fracture. Femoral impressions were described according to their local appearance and posterolateral tibial plateau fractures were described using the classification of Menzdorf et al. RESULTS: In 29 cases a significant impression in the lateral femoral condyle was detected. There was a significantly increased number of lateral meniscal (41.4% vs. 18.6% p = 0.023) and medial ligament (41.4% vs. 22.1%; p = 0.040) injuries in the group with a lateral femoral notch sign. 104 patients showed a posterolateral bone bruise or fracture of the tibial plateau. Seven of these required an intervention according to Menzdorf et al. In the group of anterior cruciate ligament injuries with posterolateral tibial plateau fracture significantly more lateral meniscus injuries were seen (p = 0.039).
In the preoperative planning of ACL rupture accompanied with a positive femoral notch sign, attention should be paid to possible medial collateral ligament and lateral meniscus injuries. As these are more likely to occur together. A posterolateral impression fracture of the tibial plateau is associated with an increased likelihood of the presence of a lateral meniscal injury. This must be considered in surgical therapy and planning and may be the indication for necessary early surgical treatment.
ACL 损伤是运动中膝关节最常见的损伤之一。随着 ACL 断裂的伴随骨损伤，描述了所谓的外侧股骨切迹征和胫骨平台后外侧骨折。然而，这些合并损伤的频率、伴随的韧带损伤以及何时以及如何治疗这些损伤尚不清楚。对于除前交叉韧带损伤外，这些骨损伤还与哪些韧带合并损伤相关，目前仍缺乏了解。
回顾性评估了我院中心进行的 115 例经证实的前交叉韧带撕裂的 MRI 扫描，以评估半月板、侧副韧带损伤、股骨印象或后外侧胫骨平台骨折的存在。根据其局部外观描述股骨印象，根据 Menzdorf 等人的分类描述后外侧胫骨平台骨折。
在 29 例中，检测到外侧股骨髁有明显的凹陷。外侧半月板（41.4%对 18.6%，p=0.023）和内侧韧带（41.4%对 22.1%，p=0.040）损伤的数量明显增加。104 例患者出现后外侧骨挫伤或胫骨平台骨折。根据 Menzdorf 等人的标准，其中 7 例需要干预。在前交叉韧带损伤合并后外侧胫骨平台骨折的患者中，外侧半月板损伤更为常见（p=0.039）。
在前交叉韧带断裂伴股骨切迹征阳性的术前规划中，应注意可能存在的内侧副韧带和外侧半月板损伤。因为这些更可能同时发生。胫骨平台后外侧凹陷骨折与外侧半月板损伤的可能性增加相关。在手术治疗和计划中应考虑到这一点，这可能是需要早期手术治疗的指征。
