Department of Orthopaedic Surgery, Washington University in St. Louis, Missouri, USA.
Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Am J Sports Med. 2023 May;51(6):1497-1505. doi: 10.1177/03635465231164952. Epub 2023 Apr 4.
Anterior cruciate ligament (ACL) injuries in adults are frequently accompanied by meniscal and articular cartilage damage. However, little is known regarding the association, if any, between physical maturity, hypermobility, or bone bruising and these associated injuries in skeletally immature patients with ACL tears.
To determine if physical maturity, hypermobility, and/or bone bruising is associated with concomitant meniscal and articular cartilage injury in skeletally immature patients with ACL tears.
Cohort study; Level of evidence, 2.
At 10 institutions in the United States, consecutive skeletally immature patients with complete ACL tears were enrolled between January 2016 and June 2020. Univariable and multivariable logistic regression analysis was used to assess the effect of variables on the likelihood of articular cartilage and meniscal injury.
A total of 748 patients were analyzed. Of these, 85 patients (11.4%) had articular cartilage injuries. These patients had a higher bone age (13.9 vs 13.1 years; = .001), a higher Tanner stage ( = .009), and increased height (162.9 vs 159.9 cm; = .03) and were heavier (57.8 vs 54.0 kg; = .02). For each additional Tanner stage, the odds of articular cartilage injury increased approximately 1.6 times ( < .001). Of the total patients, 423 (56.6%) had meniscal tears. Those with meniscal tears were older (12.6 vs 12.0 years; < .001), had a higher bone age (13.5 vs 12.8 years; < .001), had a higher Tanner stage ( = .002), had increased height (162.2 vs 157.6 cm; < .001), and were heavier (56.6 vs 51.6 kg; < .001). For each additional Tanner stage, the odds of a meniscal tear increased approximately 1.3 times ( < .001). No association was detected between hypermobility or bone bruising and the likelihood of articular cartilage or meniscal injury. Multivariable regression revealed that increasing Tanner stage was associated with an increasing risk of articular cartilage injury, while weight was associated with an increasing risk of meniscal injury.
Increasing physical maturity is associated with increased risks of concomitant articular cartilage and meniscal injury in skeletally immature patients with ACL tears. Hypermobility and bone bruising are not associated with articular cartilage or meniscal injury, suggesting that physical maturity, rather than ligamentous laxity, is the primary risk factor for associated injuries in skeletally immature patients with an ACL tear.
成人前交叉韧带（ACL）损伤常伴有半月板和关节软骨损伤。然而，对于骨骼未成熟的 ACL 撕裂患者，其与物理成熟度、过度活动或骨挫伤之间的关联，我们知之甚少。
确定骨骼未成熟的 ACL 撕裂患者中，物理成熟度、过度活动和/或骨挫伤是否与伴发的半月板和关节软骨损伤相关。
队列研究；证据等级，2 级。
在美国 10 家机构，连续纳入 2016 年 1 月至 2020 年 6 月期间患有完全 ACL 撕裂的骨骼未成熟患者。采用单变量和多变量逻辑回归分析来评估变量对关节软骨和半月板损伤可能性的影响。
共分析了 748 例患者。其中，85 例（11.4%）有软骨损伤。这些患者的骨龄更高（13.9 岁比 13.1 岁；P =.001），Tanner 分期更高（P =.009），身高更高（162.9 厘米比 159.9 厘米；P =.03），体重更重（57.8 千克比 54.0 千克；P =.02）。Tanner 分期每增加 1 期，发生关节软骨损伤的可能性约增加 1.6 倍（P <.001）。在所有患者中，423 例（56.6%）有半月板撕裂。有半月板撕裂的患者年龄更大（12.6 岁比 12.0 岁；P <.001），骨龄更高（13.5 岁比 12.8 岁；P <.001），Tanner 分期更高（P =.002），身高更高（162.2 厘米比 157.6 厘米；P <.001），体重更重（56.6 千克比 51.6 千克；P <.001）。Tanner 分期每增加 1 期，半月板撕裂的可能性约增加 1.3 倍（P <.001）。过度活动或骨挫伤与关节软骨或半月板损伤的可能性之间无关联。多变量回归显示，Tanner 分期增加与关节软骨损伤的风险增加相关，而体重与半月板损伤的风险增加相关。
骨骼未成熟的 ACL 撕裂患者中，物理成熟度的增加与伴发的关节软骨和半月板损伤的风险增加相关。过度活动和骨挫伤与关节软骨或半月板损伤无关，提示在 ACL 撕裂的骨骼未成熟患者中，与韧带松弛相比，物理成熟度是伴发损伤的主要危险因素。
