Department of Orthopedics, Vydehi Institute of Medical Sciences, Whitefield, Bangalore, Karnataka, India.
Eur J Orthop Surg Traumatol. 2023 May;33(4):1267-1274. doi: 10.1007/s00590-022-03288-x. Epub 2022 May 24.
This study aims to compare variables such as medial posterior tibial slope, lateral posterior tibial slope, medial tibial plateau depth calculated by preoperative MRI, and posterior tibial slope calculated by lateral knee X-ray on randomly selected patients with ACL injuries to a control group of patients without the injury. The secondary aim is to determine the critical value of these parameters and ascertain whether they can be used as a screening tool to identify at-risk individuals.
Study participants included 426 subjects with noncontact knee injuries. Using stratified systematic random sampling, they were randomly divided into two equal groups of sixty, one for patients with ACL tears, and the other for those with ACL that was intact based on clinical and MRI findings. Based on the blinded assessment, MPTS, LPTS, MTPD, and PTS were assessed in MRI and lateral knee X-ray (PTS only), and the results were compared between groups using appropriate statistical models.
There were higher MPTS, LPTS, and PTS scores in the ACL tear group when compared to the control group (p < 0.01), while MTPD was lower when compared to the control group (p > 0.05). ROC analysis for predicting ACL tear revealed an area under the curve for MPTS, LPTS, PTS, and MTPD as 0.942, 0.907, 0.967, and 0.878, respectively. The critical angle for MPTS, LTPS, PTS and MTPD was 8.25°,6.75°,8.5° and 2.25 mm, respectively, which has sensitivity of 91.0%, 86.7%, 93.3% and 80%; specificity of 86.7%, 78.3%, 90.0% and 71.7%, respectively.
Medial posterior tibial slope, lateral posterior tibial slope, and posterior tibial slope were significantly higher in individuals in the ACL tear group but there was no significant difference in medial tibial plateau depth. MPTS, LPTS, and PTS are better predictors of identifying at-risk individuals predisposed to ACL injury than MTPD.
本研究旨在比较内侧后胫骨斜率、外侧后胫骨斜率、术前 MRI 计算的内侧胫骨平台深度以及外侧膝关节 X 射线计算的后胫骨斜率等变量，以随机选择的 ACL 损伤患者为观察组，并与无损伤患者的对照组进行比较。次要目标是确定这些参数的临界值，并确定它们是否可用作识别高危个体的筛查工具。
研究参与者包括 426 名非接触性膝关节损伤患者。使用分层系统随机抽样，将他们随机分为两组，每组 60 名，一组为 ACL 撕裂患者，另一组为根据临床和 MRI 发现 ACL 完整的患者。基于盲法评估，在 MRI 和外侧膝关节 X 射线（仅 PTS）中评估 MPTS、LPTS、MTPD 和 PTS，并使用适当的统计模型比较组间结果。
与对照组相比，ACL 撕裂组的 MPTS、LPTS 和 PTS 评分更高（p<0.01），而 MTPD 则更低（p>0.05）。ROC 分析预测 ACL 撕裂显示 MPTS、LPTS、PTS 和 MTPD 的曲线下面积分别为 0.942、0.907、0.967 和 0.878。MPTS、LTPS、PTS 和 MTPD 的临界角分别为 8.25°、6.75°、8.5°和 2.25mm，其灵敏度分别为 91.0%、86.7%、93.3%和 80%；特异性分别为 86.7%、78.3%、90.0%和 71.7%。
ACL 撕裂组患者的内侧后胫骨斜率、外侧后胫骨斜率和后胫骨斜率显著升高，但内侧胫骨平台深度无显著差异。MPTS、LPTS 和 PTS 比 MTPD 更能预测 ACL 损伤高危个体。
