Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA.
Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, California, USA.
Am J Sports Med. 2024 May;52(6):1498-1504. doi: 10.1177/03635465241240792. Epub 2024 Apr 15.
Recent adult studies have demonstrated that decreased posterior tibial slope angle (PTSA) may be a risk factor for posterior cruciate ligament (PCL) injury. However, there is no study investigating this phenomenon in a pediatric population. Understanding risk factors for PCL injuries among a pediatric population is important given the recent rise in athletic competition/specialization and sports-related injuries.
HYPOTHESIS/PURPOSE: The purpose of this study was to compare PTSA between pediatric patients sustaining a primary PCL tear compared with age- and sex-matched controls. It was hypothesized that pediatric patients sustaining a PCL tear would have a decreased PTSA compared with controls, with decreased PTSA being associated with higher odds of PCL injury.
Cohort study; Level of evidence, 3.
The records of all patients sustaining a PCL injury between 2006 and 2021 at a level 1 pediatric trauma center were reviewed. Patients aged ≤18 years with magnetic resonance imaging-confirmed PCL tear were included. Excluded were patients with concomitant anterior cruciate ligament tears, previous PCL reconstruction, or previous coronal plane realignment. A control cohort, with their ligament shown as intact on magnetic resonance imaging scans, was matched based on age and sex. PTSA was measured on lateral radiographs of the injured knee or tibia. The mean PTSA was compared between cohorts, and odds ratios were calculated based on the normal slope range (7°-10°) described in the literature, an upper range (>10°), and a lower range (<7°). Inter- and intrarater reliability were determined via calculation of an intraclass correlation coefficient.
Of the 98 patients who sustained a PCL injury in this study period, 59 (60%) met inclusion criteria, and 59 healthy knee controls were matched. There were no differences between the cohorts for age ( = .90), sex ( > .99), or body mass index ( = .74). The PCL cohort had a lower mean ± SD PTSA compared with the control group (5.9°± 2.7° vs 7.3°± 4.3°; = .03). PTSA <7° was associated with a 2.8 (95% CI, 1.3-6.0; = .01) times risk of PCL tear. Conversely, PTSA >10° was associated with a 0.27 (95% CI, 0.09-0.81; = .02) times risk of PCL tear. These PTSA measurements demonstrated acceptable intrarater and interrater reliability.
PTSA <7° was associated with an increased odds of PCL injury, whereas a slope >10° was associated with a decreased odds of PCL injury in a pediatric population. These findings corroborate similar outcomes in adult studies; however, further studies are needed to elucidate PTSA as a risk factor for PCL injury.
最近的成人研究表明，后胫骨倾斜角（PTSA）减小可能是后交叉韧带（PCL）损伤的一个危险因素。然而，在儿科人群中，没有研究调查这种现象。了解儿科人群中 PCL 损伤的危险因素很重要，因为最近竞技/专业化和与运动相关的受伤有所增加。
假设/目的：本研究旨在比较原发性 PCL 撕裂的儿科患者与年龄和性别匹配的对照组之间的 PTSA。假设 PCL 撕裂的儿科患者 PTSA 较对照组降低，PTSA 降低与 PCL 损伤的几率增加相关。
队列研究；证据水平，3 级。
回顾了 2006 年至 2021 年在一家 1 级儿科创伤中心接受 PCL 撕裂治疗的所有患者的记录。纳入了年龄≤18 岁且 MRI 证实 PCL 撕裂的患者。排除了同时伴有前交叉韧带撕裂、既往 PCL 重建或既往冠状面矫正的患者。根据文献中描述的正常斜率范围（7°-10°）、上限（>10°）和下限（<7°），基于年龄和性别匹配了具有完整 MRI 扫描的韧带的对照组。在受伤的膝关节或胫骨的侧位 X 光片上测量 PTSA。比较两组之间的平均 PTSA，并根据正常斜率范围（7°-10°）计算比值比，上限（>10°）和下限（<7°）。通过计算组内相关系数来确定组内和组间的可靠性。
在本研究期间，98 名患有 PCL 损伤的患者中，有 59 名（60%）符合纳入标准，并与 59 名健康膝关节对照组相匹配。两组在年龄（ =.90）、性别（ >.99）或体重指数（ =.74）方面无差异。PCL 组的平均 PTSA 较对照组低（5.9°±2.7°比 7.3°±4.3°； =.03）。PTSA <7°与 PCL 撕裂的风险增加 2.8 倍（95%CI，1.3-6.0； =.01）相关。相反，PTSA >10°与 PCL 撕裂的风险降低 0.27 倍（95%CI，0.09-0.81； =.02）相关。这些 PTSA 测量结果具有可接受的组内和组间可靠性。
在儿科人群中，PTSA <7°与 PCL 损伤的几率增加相关，而 PTSA >10°与 PCL 损伤的几率降低相关。这些发现与成人研究中的类似结果相符；然而，需要进一步的研究来阐明 PTSA 作为 PCL 损伤的危险因素。
