Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Orthopedic Surgery and Traumatology, University of Ankara, Ankara, Turkey.
Knee Surg Sports Traumatol Arthrosc. 2023 Oct;31(10):4080-4089. doi: 10.1007/s00167-023-07472-2. Epub 2023 Jul 6.
Variations in femoral and tibial bony morphology have been associated with higher clinical grading and increased quantitative tibial translation, but not tibial acceleration, during the pivot shift test following anterior cruciate ligament (ACL) injury. The purpose of this study was to determine the impact of femoral and tibial bony morphology, including a measurement influenced by both parameters (the Lateral Tibiofemoral Articular Distance (LTAD)), on the degree of quantitative tibial acceleration during the pivot shift test and rates of future ACL injury.
All patients who underwent primary ACL reconstruction from 2014 to 2019 by a senior orthopedic surgeon with available quantitative tibial acceleration data were retrospectively reviewed. All patients underwent a pivot shift examination under anesthesia with a triaxial accelerometer. Measurements of femoral and tibial bony morphology were performed by two fellowship-trained orthopedic surgeons using preoperative magnetic resonance imaging and lateral radiographs.
Fifty-one patients were included at a mean follow-up of 4.4 years. The mean quantitative tibial acceleration during the pivot shift was 13.8 m/s (range: 4.9-52.0 m/s). A larger Posterior Condylar Offset Ratio (r = 0.30, p = 0.045), smaller medial-to-lateral width of the medial tibial plateau (r = - 0.29, p = 0.041), lateral tibial plateau (r = - 0.28, p = 0.042), and lateral femoral condyle (r = - 0.29, p = 0.037), and a decreased LTAD (r = - 0.53, p < 0.001) significantly correlated with increased tibial acceleration during the pivot shift. Linear regression analysis demonstrated an increase in tibial acceleration of 1.24 m/s for every 1 mm decrease in LTAD. Nine patients (17.6%) sustained ipsilateral graft rupture and 10 patients (19.6%) sustained contralateral ACL rupture. No morphologic measurements were associated with rates of future ACL injury.
Increased convexity and smaller bony morphology of the lateral femur and tibia were significantly associated with increased tibial acceleration during the pivot shift. Additionally, a measurement, termed the LTAD, was found to have the strongest association with increased tibial acceleration. Based on the results of this study, surgeons can utilize these measurements to preoperatively identify patients at risk of increased rotatory knee instability.
Level IV.
在前交叉韧带（ACL）损伤后的膝关节旋转试验中，股骨和胫骨的骨形态变化与较高的临床分级和增加的定量胫骨移位有关，但与胫骨加速度无关。本研究的目的是确定股骨和胫骨的骨形态变化（包括受这两个参数影响的测量值[外侧胫骨股骨关节距离（LTAD）]）对膝关节旋转试验中定量胫骨加速度的影响，以及 ACL 损伤的未来发生率。
回顾性分析 2014 年至 2019 年间由一位资深骨科医生进行的初次 ACL 重建且有定量胫骨加速度数据的所有患者。所有患者均在全身麻醉下接受膝关节旋转试验，使用三轴加速度计。两名接受过 fellowship培训的骨科医生使用术前磁共振成像和侧位 X 线片进行股骨和胫骨骨形态的测量。
51 例患者平均随访 4.4 年。膝关节旋转试验中定量胫骨加速度的平均值为 13.8 m/s（范围：4.9-52.0 m/s）。较大的后髁外偏距比（r=0.30，p=0.045）、较小的内侧胫骨平台的内-外侧宽度（r=-0.29，p=0.041）、外侧胫骨平台（r=-0.28，p=0.042）和外侧股骨髁（r=-0.29，p=0.037），以及 LTAD 的降低（r=-0.53，p<0.001）与膝关节旋转试验中胫骨加速度的增加显著相关。线性回归分析表明，LTAD 每减少 1mm，胫骨加速度增加 1.24m/s。9 例（17.6%）患者同侧移植物断裂，10 例（19.6%）患者对侧 ACL 断裂。没有形态学测量与 ACL 损伤的未来发生率相关。
外侧股骨和胫骨的凸度增加和较小的骨形态与膝关节旋转试验中胫骨加速度的增加显著相关。此外，一项名为 LTAD 的测量值与胫骨加速度的增加相关性最强。基于本研究的结果，外科医生可以在术前利用这些测量值识别有增加的膝关节旋转不稳定性风险的患者。
IV 级。
