Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China.
Department of Epidemiology and Biostatistics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Beijing, China.
Am J Sports Med. 2023 Mar;51(4):968-976. doi: 10.1177/03635465231151694. Epub 2023 Feb 13.
Anterior tibial subluxation (ATS) of the lateral compartment entails a pathological tibiofemoral alignment in knees with anterior cruciate ligament (ACL) injury. Causes of increased ATS after an acute ACL injury are not clear, but soft tissue abnormalities and bony variations of the knee are potential causes.
To determine whether increased ATS of the lateral compartment in knees with acute ACL injury is associated with (1) anterolateral ligament (ALL) status and (2) inherent anatomy of the lateral femoral condyle (LFC) and lateral tibial plateau (LTP).
Cross-sectional study; Level of evidence, 3.
A total of 337 patients with clinically diagnosed ACL injuries treated between September 2019 and August 2021 were retrospectively reviewed, and 119 patients with acute ACL injury were included. Of them, 79 patients with impaired ALL (ALL injury group) and 40 patients with intact ALL (ALL intact group) were identified based on magnetic resonance imaging (MRI). The ATS of the lateral compartment measured on MRI was compared between the 2 groups. The bony anatomy of knees, quantified by the LFC length, LFC height, LTP length, and LTP slope, was also evaluated on MRI and correlated with the ATS with partial correlation coefficients. Multivariate linear regression was used to identify the independent predictors of increased ATS.
The ATS of the lateral compartment in the ALL injury group was significantly larger than that in the ALL intact group (6.3 mm vs 4.0 mm, respectively; = .001). In all included patients, the presence of ALL injuries independently predicted a mean increase in ATS of 1.8 mm ( = .003). In the ALL injury group, ATS was significantly correlated with LFC length ( = 0.463; < .001), LFC height ( = -0.415; < .001), and LTP slope ( = 0.453; < .001); further, a 1-mm increase in LFC length, 1-mm decrease in LFC height, and 1° increase in LTP slope independently predicted a mean increase in ATS of 0.7 mm ( < .001), 0.6 mm ( < .001), and 0.5 mm ( < .001), respectively. In the ALL intact group, there was no significant correlation between ATS and any bony parameter.
An impaired ALL increased the ATS of the lateral compartment after acute ACL injuries. In patients with combined ALL injuries, a flatter LFC and a steeper LTP in the sagittal plane were predictors of a further increase in ATS.
外侧间室胫骨前侧半脱位（ATS）是前交叉韧带（ACL）损伤膝关节病理性胫股对线的结果。ACL 急性损伤后 ATS 增加的原因尚不清楚，但膝关节的软组织异常和骨变异可能是其原因。
确定急性 ACL 损伤膝关节中外侧间室 ATS 的增加是否与（1）前外侧韧带（ALL）状态和（2）外侧股骨髁（LFC）和外侧胫骨平台（LTP）的固有解剖结构有关。
横断面研究；证据水平，3 级。
回顾性分析 2019 年 9 月至 2021 年 8 月期间临床诊断为 ACL 损伤的 337 例患者，其中纳入 119 例 ACL 急性损伤患者。根据 MRI 确定 79 例存在 ALL 损伤（ALL 损伤组）和 40 例 ALL 完整（ALL 完整组）的患者。比较两组间 MRI 测量的外侧间室 ATS。还通过 MRI 评估膝关节的骨骼解剖结构，通过外侧股骨髁长度、外侧股骨髁高度、外侧胫骨平台长度和外侧胫骨平台斜率进行量化，并通过偏相关系数与 ATS 进行相关性分析。使用多元线性回归确定 ATS 增加的独立预测因素。
ALL 损伤组的外侧间室 ATS 明显大于 ALL 完整组（分别为 6.3 mm 和 4.0 mm； =.001）。在所有纳入的患者中，ALL 损伤的存在独立预测 ATS 平均增加 1.8 mm（ =.003）。在 ALL 损伤组中，ATS 与 LFC 长度（ = 0.463； <.001）、LFC 高度（ = -0.415； <.001）和 LTP 斜率（ = 0.453； <.001）显著相关；进一步，LFC 长度增加 1mm、LFC 高度减少 1mm 和 LTP 斜率增加 1°分别独立预测 ATS 平均增加 0.7 mm（ <.001）、0.6 mm（ <.001）和 0.5 mm（ <.001）。在 ALL 完整组中，ATS 与任何骨骼参数之间均无显著相关性。
ACL 急性损伤后，ALL 损伤会增加外侧间室 ATS。在合并 ALL 损伤的患者中，更平坦的 LFC 和更陡峭的 LTP 在矢状面上是 ATS 进一步增加的预测因素。
