Shi Brendan Y, Levine Benjamin, Ghazikhanian Varand, Bugarin Amador, Schroeder Grant, Wu Shannon, Kremen Thomas, Jones Kristofer
Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA.
Department of Diagnostic Radiology, University of California, Los Angeles, Los Angeles, California, USA.
Orthop J Sports Med. 2022 Oct 26;10(10):23259671221128601. doi: 10.1177/23259671221128601. eCollection 2022 Oct.
While studies have described Kaplan fiber (KF) injury in up to 60% of adults with anterior cruciate ligament (ACL) tears, the incidence of KF injury in the pediatric and adolescent population remains unknown.
To (1) determine the reliability of using magnetic resonance imaging (MRI) to identify KF injury in the pediatric and adolescent population and (2) define the incidence of KF injury in these patients with acute ACL injuries.
Cohort study (diagnosis); Level of evidence, 3.
The authors retrospectively identified patients ≤18 years of age who underwent ACL reconstruction for acute tears between 2013 and 2020. All preoperative MRI scans were reviewed independently and in a blinded fashion by 2 musculoskeletal radiologists, who noted the presence of the KF complex and any evidence of injury; interrater reliability was assessed. Patient characteristics, time from injury to MRI, laterality, and concomitant ligamentous or meniscal injuries were recorded, and associations between patient or injury characteristics and KF integrity on MRI were assessed.
In total, 51 patients (mean age, 14.9 years) met the inclusion criteria. Of these, 27 patients were female and 31 sustained an injury to the right knee. With respect to KF integrity, radiologist 1 visualized KF injury in 29% of patients, while radiologist 2 visualized KF injury in 35% of patients. In 12% of cases for radiologist 1 and 6% of cases for radiologist 2, KFs were unable to be visualized at all. The overall percentage agreement between the 2 radiologists was 76.5% with a kappa statistic of 0.57 (moderate agreement). There were no significant associations found between the presence of KF injury and patient age, sex, laterality, body mass index, concomitant ligamentous injury, or meniscal injury. However, visualization of KF injury on MRI was associated with a shorter time from index injury to MRI (15 days vs 23 days; P = .044).
Approximately one-third of pediatric and adolescent patients who underwent ACL reconstruction were found to have KF injuries. Standard preoperative MRI scans can reliably be used to visualize KF injury in the majority of pediatric and adolescent patients with ACL tears, especially when the MRI is performed in the acute setting.
虽然研究表明，在高达60%的成人前交叉韧带（ACL）撕裂患者中存在卡普兰纤维（KF）损伤，但儿童和青少年人群中KF损伤的发生率仍然未知。
（1）确定使用磁共振成像（MRI）识别儿童和青少年人群中KF损伤的可靠性，以及（2）确定这些急性ACL损伤患者中KF损伤的发生率。
队列研究（诊断）；证据等级，3级。
作者回顾性纳入了2013年至2020年间因急性撕裂而接受ACL重建的18岁及以下患者。所有术前MRI扫描均由2名肌肉骨骼放射科医生独立且以盲法进行评估，他们记录KF复合体的存在情况以及任何损伤证据；评估了评分者间的可靠性。记录患者的特征、从受伤到进行MRI检查的时间、损伤侧别以及合并的韧带或半月板损伤情况，并评估患者或损伤特征与MRI上KF完整性之间的关联。
共有51例患者（平均年龄14.9岁）符合纳入标准。其中，27例为女性，31例右膝受伤。关于KF的完整性，放射科医生1在29%的患者中发现了KF损伤，而放射科医生2在35%的患者中发现了KF损伤。放射科医生1有12%的病例、放射科医生2有6%的病例完全无法看到KF。两位放射科医生的总体百分比一致性为76.5%，kappa统计值为0.57（中度一致性）。在KF损伤的存在与患者年龄、性别、侧别、体重指数、合并的韧带损伤或半月板损伤之间未发现显著关联。然而，MRI上显示KF损伤与从受伤到进行MRI检查的时间较短有关（15天对23天；P = 0.044）。
在接受ACL重建的儿童和青少年患者中，约三分之一被发现存在KF损伤。标准的术前MRI扫描能够可靠地用于在大多数ACL撕裂的儿童和青少年患者中显示KF损伤，尤其是在急性期进行MRI检查时。
