Departments of Orthopaedics.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
J Pediatr Orthop. 2022 Apr 1;42(4):e349-e355. doi: 10.1097/BPO.0000000000002078.
Magnetic resonance imaging (MRI) sagittal alignment is a measure that has been described and validated in the adult population as a means of distinguishing normal knees from those with anterior cruciate ligament (ACL) injury, but this measure has not been formally assessed among pediatric patients. The purpose of this study was to (1) assess the reliability of this MRI-based measure in a pediatric cohort, and (2) validate its ability to distinguish between ACL and non-ACL-injured knees in this population.
A consecutive series of knee MRI examinations performed at our center were reviewed to identify studies of pediatric patients (1) with ACL injury, and (2) without significant pathology. Patient age, sex, physeal status (open, closing, or closed), knee laterality, and magnet strength (1.5 or 3-Tesla) were collected. The sagittal alignment was measured in both medial and lateral tibiofemoral compartments using a previously described method. Mean anterior tibial translation was then calculated for each study. Inter-rater and intrarater reliability testing was performed on a subset of randomly-selected patients from each cohort by three raters by calculating intraclass correlation coefficients. Sagittal alignment measurements of all patients were then completed by a single author after reliability was confirmed. The medial and lateral compartment translation and mean anterior tibial translation measurements of normal and ACL-injured knees were compared.
Inclusion criteria were met by 131 studies: 86 from uninjured knees (normal cohort) and 45 knees with ACL injury (ACL cohort). Studies were performed at a mean age of 13.4 with a near equivalent sex distribution. Inter-rater and intrarater reliability were good to excellent for all measures for patients in both normal and ACL cohorts. Normal and ACL-injured knees demonstrated a significant difference in anterior tibial translation in all measured regions. The mean anterior tibia translation for ACL-injured knees was 2.01 mm (95% confidence interval: 1.03-2.98) versus -0.44 mm (95% confidence interval: -0.89-0.014).
This study identified good to excellent inter-rater and intrarater reliability of knee sagittal alignment measurements among pediatric patients. It also demonstrated a significant difference in medial compartment, lateral compartment, and mean tibial translation in patients with and without ACL injury, validating previous findings demonstrated in adult cohorts. These findings may be useful in assisting providers in the confirmation of suspected ACL injury and insufficiency and guide operative management in cases of clinical uncertainty.
Level III-retrospective comparative study.
磁共振成像（MRI）矢状位定位已在成人人群中得到描述和验证，可作为区分正常膝关节和前交叉韧带（ACL）损伤膝关节的一种方法，但尚未在儿科患者中进行正式评估。本研究的目的是：（1）评估该 MRI 测量方法在儿科患者中的可靠性；（2）验证其在该人群中区分 ACL 损伤和非 ACL 损伤膝关节的能力。
回顾性分析我院行膝关节 MRI 检查的连续病例，以确定以下患者的研究：（1）ACL 损伤；（2）无明显病理改变。收集患者年龄、性别、骺板状态（开放、闭合或闭合）、膝关节侧别和磁场强度（1.5 或 3 特斯拉）。使用先前描述的方法在内外侧胫骨股骨间隙测量矢状位定位。然后计算每个研究的平均胫骨前向平移。通过三位评估者对每个队列中的随机选择患者进行组内和组间可靠性测试，计算组内相关系数。在确认可靠性后，由一位作者完成所有患者的矢状位定位测量。比较正常和 ACL 损伤膝关节的内外侧间隙平移和平均胫骨前向平移测量值。
纳入标准符合 131 项研究：86 项来自未受伤膝关节（正常组），45 项来自 ACL 损伤膝关节（ACL 组）。研究平均年龄为 13.4 岁，性别分布相近。正常组和 ACL 组患者的所有测量值的组内和组间可靠性均为良好至极好。正常和 ACL 损伤膝关节在所有测量区域的胫骨前向平移均有显著差异。ACL 损伤膝关节的平均胫骨前向平移为 2.01mm（95%置信区间：1.03-2.98），而正常膝关节为-0.44mm（95%置信区间：-0.89-0.014）。
本研究确定了儿科患者膝关节矢状位定位测量的良好至极好的组内和组间可靠性。它还证明了 ACL 损伤和不健全患者内外侧间隙和平均胫骨平移的显著差异，验证了在成人队列中已证明的先前发现。这些发现可能有助于提供者确认疑似 ACL 损伤和不足，并在临床不确定的情况下指导手术治疗。
三级-回顾性比较研究。
