Department of Sports Medicine, Peking University Third Hospital, No. 49, Huayuanbei Road, Haidian District, Beijing, China.
Institute of Sports Medicine, Peking University, Beijing, China.
Knee Surg Sports Traumatol Arthrosc. 2022 Oct;30(10):3350-3360. doi: 10.1007/s00167-022-06913-8. Epub 2022 Feb 26.
Anatomic factors, such as posterior tibial slope (PTS) and anterior tibial subluxation (ATS) obtained by quantitative measurement, have been proposed as predictors for clinical outcomes of anterior cruciate ligament (ACL) reconstruction. However, the correlation between PTS and ATS is controversial, and the method for quantitative ATS measurement remains unsettled. This study aimed to identify the correlation between PTS and ATS in patients with injured and intact ACLs and compare the two ATS measuring protocols.
This study included 128 ACL-injured and 176 ACL-intact patients with no concomitant ligament injuries. PTS and ATS were measured on sagittal MRI. ATS was measured using two measuring protocols, including the modified protocol using the longitudinal tibial axis (axis protocol) and the established protocol using a line perpendicular to the tibial plateau (plateau protocol). Correlation analyses between PTS and ATS and between PTS and the difference in the ATS value measured under the two protocols (ATS) were performed. The difference between the two ATS measuring protocols was further analyzed by trigonometric analysis. Intra- and interobserver reliability tests were performed for the axis protocol.
Under the axis protocol, ATS was positively correlated with PTS in both the ACL-injured and ACL-intact groups (p < 0.001). Under the plateau protocol, no correlation was observed in the ACL-injured group. In the ACL-intact group, no correlation was observed for lateral ATS, and a negative correlation was observed for medial ATS (p = 0.001). ATS was positively correlated with PTS (p < 0.001), indicating that the two protocols varied greatly in those with a steep PTS. Trigonometric analysis showed that a steep PTS influenced the measurement of ATS under the plateau protocol but not the axis protocol. Intra- and interobserver reliability tests showed good-to-excellent strength of reliability for the ATS measurement under the axis protocol.
ATS measured under the axis protocol was positively correlated with PTS, indicating that a steep PTS was associated with a worse anatomic tibiofemoral relationship. The axis protocol for ATS measurement is a promising method for clinical use since it is not influenced by PTS and reflects the global position of the tibia.
III.
解剖因素，如通过定量测量获得的胫骨后倾角（PTS）和胫骨前侧半脱位（ATS），已被提出作为前交叉韧带（ACL）重建临床结果的预测因子。然而，PTS 和 ATS 之间的相关性存在争议，ATS 的定量测量方法仍未确定。本研究旨在确定损伤和未损伤 ACL 患者中 PTS 和 ATS 之间的相关性，并比较两种 ATS 测量方案。
本研究纳入了 128 例 ACL 损伤患者和 176 例 ACL 未损伤患者，且均无其他韧带损伤。在矢状面 MRI 上测量 PTS 和 ATS。使用两种测量方案测量 ATS，包括使用胫骨长轴的改良方案（轴线方案）和使用垂直于胫骨平台的线的既定方案（平台方案）。对 PTS 和 ATS 之间以及 PTS 和两种方案下测量的 ATS 值差异（ATS）之间的相关性进行分析。进一步通过三角分析对两种 ATS 测量方案之间的差异进行分析。对轴线方案进行了观察者内和观察者间可靠性测试。
在轴线方案中，ACL 损伤组和 ACL 未损伤组中 ATS 均与 PTS 呈正相关（p<0.001）。在 ACL 损伤组中，在平台方案中未观察到相关性。在 ACL 未损伤组中，外侧 ATS 无相关性，内侧 ATS 呈负相关（p=0.001）。ATS 与 PTS 呈正相关（p<0.001），表明在 PTS 陡峭的患者中，两种方案的差异较大。三角分析显示，陡峭的 PTS 影响了平台方案下 ATS 的测量，但不影响轴线方案。轴线方案下 ATS 测量的观察者内和观察者间可靠性测试显示出良好到极好的可靠性。
轴线方案下测量的 ATS 与 PTS 呈正相关，表明陡峭的 PTS 与更差的解剖性胫股关系相关。ATS 测量的轴线方案是一种有前途的临床应用方法，因为它不受 PTS 的影响，并且反映了胫骨的整体位置。
III 级。
