外侧间室胫骨前侧半脱位与急性而非慢性前交叉韧带损伤的高等级旋转不稳定性相关：一项磁共振成像病例对照研究。
Anterior Tibial Subluxation of Lateral Compartment Is Associated With High-Grade Rotatory Instability for Acute But Not Chronic Anterior Cruciate Ligament Injuries: An Magnetic Resonance Imaging Case-Control Study.
机构信息
Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, Orthopedics Research Institute of Zhejiang University, Hangzhou, China.
Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, Orthopedics Research Institute of Zhejiang University, Hangzhou, China.
出版信息
Arthroscopy. 2022 Oct;38(10):2852-2860. doi: 10.1016/j.arthro.2022.04.012. Epub 2022 May 10.
PURPOSE
To investigate whether anterior tibial subluxation obtained from magnetic resonance imaging (MRI) could be a predictor of high-grade rotatory instability for anterior cruciate ligament (ACL) injuries, including acute and chronic cases.
METHODS
From September 2016 to August 2018, we retrospectively investigated 163 patients with ACL injuries who subsequently underwent primary ACL reconstruction. Among them, 30 patients with high-grade rotatory instability (grade II/III pivot shift) were included in the high-grade group, and their age and sex were matched 1:2 to low-grade cases (<grade II pivot shift). On preoperative MRI, we measured anterior tibial subluxation, posterior tibial slope, as well as the time from injury to surgery. Meniscal lesions were documented from arthroscopy. Multivariable logistic regression was used to determine predictors of high-grade rotatory instability. Furthermore, subgroup comparisons between 2 groups were divided into acute (≤3 months) and chronic (>3 months) phases.
RESULTS
The high-grade group had a larger anterior tibial subluxation of lateral compartment (8.1 mm vs 5.9 mm; P =.004) than the low-grade group, whereas no significant difference was found in anterior tibial subluxation of medial compartment (P > .05). Moreover, high-grade anterior tibial subluxation of lateral compartment (≥6 mm) was found to be an independent predictor (odds ratio, 12.992; P = .011) associated with concomitant meniscal tears after ACL injuries. Anterior tibial subluxation of lateral compartment demonstrated statistical significance between the two groups when comparing subgroups within 3 months but not beyond 3 months.
CONCLUSION
In ACL-injured patients, high-grade anterior tibial subluxation of lateral compartment (≥6 mm) could be a unique predictor of high-grade knee rotatory instability for acute but not chronic injuries. Prolonged time from injury to surgery and lateral meniscus tears were risk factors for high-grade rotatory laxity in chronic patients.
LEVEL OF EVIDENCE
Level III, retrospective prognostic trial.
目的
探讨 MRI 检查中胫骨前侧半脱位能否预测前交叉韧带（ACL）损伤的高级别旋转不稳定，包括急性和慢性损伤。
方法
回顾性分析 2016 年 9 月至 2018 年 8 月期间我院收治的 163 例 ACL 损伤患者，这些患者均接受了初次 ACL 重建。其中，30 例患者存在高级别旋转不稳定（Ⅱ/Ⅲ 级膝关节前抽屉试验）被纳入高级别组，年龄和性别与低级别组（＜Ⅱ级膝关节前抽屉试验）相匹配。术前 MRI 测量胫骨前侧半脱位、胫骨后倾角以及从受伤到手术的时间。关节镜检查记录半月板损伤情况。采用多变量逻辑回归确定高级别旋转不稳定的预测因素。此外，两组之间的亚组比较分为急性（≤3 个月）和慢性（＞3 个月）两个阶段。
结果
高级别组的外侧胫骨前侧半脱位大于低级别组（8.1mm 比 5.9mm；P=0.004），而内侧胫骨前侧半脱位差异无统计学意义（P＞0.05）。此外，高级别外侧胫骨前侧半脱位（≥6mm）是 ACL 损伤后合并半月板撕裂的独立预测因素（优势比，12.992；P=0.011）。在比较 3 个月内的亚组时，两组间外侧胫骨前侧半脱位存在统计学差异，但在 3 个月以上的亚组中无统计学差异。
结论
在 ACL 损伤患者中，高级别外侧胫骨前侧半脱位（≥6mm）可能是急性损伤而不是慢性损伤的高级别膝关节旋转不稳定的独特预测因素。从受伤到手术的时间延长和外侧半月板撕裂是慢性患者高级别旋转松弛的危险因素。
证据等级
III 级，回顾性预后试验。
Zotero 插件