Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, 12513 PA, USA; Department of Trauma Surgery, University Hospital Zurich, 8091 Zurich, Switzerland.
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, 12513 PA, USA.
J ISAKOS. 2022 Dec;7(6):189-194. doi: 10.1016/j.jisako.2022.06.002. Epub 2022 Jul 4.
Concomitant anterolateral complex (ALC) injury may contribute to persistent rotatory knee instability following anterior cruciate ligament (ACL) reconstruction. There is no consensus on how to best identify concomitant ALC injury preoperatively, nor how well ALC injury identified on imaging modalities correlates with clinical examination of knee instability. The purpose of this retrospective study was to determine the incidence of concomitant ALC injury in ACL-injured knees, as determined by arthroscopy to preoperative radiography, ultrasound, and MRI.
A total of 117 patients with a unilateral primary ACL injury who underwent individualized anatomic ACLR between June 2016 and May 2019 were enrolled. Preoperative imaging modalities, including X-ray, ultrasound, and MRI, were evaluated for concomitant ALC injury. Clinical examination under anesthesia, including the anterior drawer, Lachman, and pivot shift tests were performed. Anterolateral capsule injury, as defined by hemorrhage and/or capsular tearing on diagnostic arthroscopy, was also determined. Correlative analyses of ALC injury incidence and severity were performed across imaging modalities and against clinical examination grades.
ALC injury incidence across imaging modalities was as follows: X-ray (3%), arthroscopy (19%), MRI (53%), and US (63%). The ALC injury rate on arthroscopy was significantly less than MRI (p < 0.001) or ultrasound (p < 0.001). ALC injury incidence and severity were significantly correlated between MRI and US grading scales (p = 0.02), but no correlations among other imaging modalities were found. Similarly, no imaging modality meaningfully correlated with physical examination maneuvers.
The incidence of ALC injury varies across imaging modalities, with lower injury rates found on arthroscopy (19%) compared to MRI (53%) and US (63%). Increasing ALC injury severity grades on imaging does not predict increasing anterolateral knee laxity on clinical examination.
V, retrospective case series.
前交叉韧带（ACL）重建后持续性旋转性膝关节不稳定可能与前外侧复合体（ALC）损伤有关。目前对于如何最好地术前识别并发 ALC 损伤尚未达成共识，也无法确定影像学上识别的 ALC 损伤与膝关节不稳定的临床检查之间的相关性如何。本回顾性研究的目的是通过关节镜检查确定 ACL 损伤膝关节并发 ALC 损伤的发生率，并与术前 X 线、超声和 MRI 进行比较。
共纳入 117 例单侧初次 ACL 损伤患者，于 2016 年 6 月至 2019 年 5 月接受个体化解剖 ACLR。评估术前影像学包括 X 线、超声和 MRI 是否存在并发 ALC 损伤。在全身麻醉下进行临床检查，包括前抽屉试验、lachman 试验和髌股关节旋转试验。还通过诊断性关节镜检查确定前外侧囊损伤，即出血和/或囊撕裂。对不同影像学检查方法和临床检查分级之间的 ALC 损伤发生率和严重程度进行相关性分析。
不同影像学方法的 ALC 损伤发生率如下：X 线（3%）、关节镜（19%）、MRI（53%）和 US（63%）。关节镜下 ALC 损伤率明显低于 MRI（p<0.001）或超声（p<0.001）。MRI 和 US 分级之间的 ALC 损伤发生率和严重程度显著相关（p=0.02），但其他影像学方法之间无相关性。同样，没有影像学方法与体格检查结果有意义的相关性。
ALC 损伤的发生率在不同的影像学方法中有所不同，关节镜（19%）下的损伤率低于 MRI（53%）和 US（63%）。影像学上 ALC 损伤程度的增加并不能预测临床检查时前外侧膝关节松弛度的增加。
V，回顾性病例系列研究。
