Lucidi Gian Andrea, Zsidai Bálint, Giusto Joseph D, Kuroda Ryosuke, Irrgang James J, Samuelsson Kristian, Zaffagnini Stefano, Musahl Volker
Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, USA; Clinica II, IRCCS, Istituto Ortopedico Rizzoli Istituto di Ricovero e Cura a Carattere Scientifico, Via Pupilli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Anatomy Centre, University of Bologna, Via Irnerio, Bologna, Italy.
Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
J ISAKOS. 2024 Dec;9(6):100319. doi: 10.1016/j.jisako.2024.100319. Epub 2024 Sep 10.
Biomechanical investigations conducted in vitro have elucidated the detrimental impact of lateral meniscus posterior root (LMPR) tears on knee contact pressures in the anterior cruciate ligament (ACL)-injured knee. Nevertheless, the influence of LMPR tears on the kinematics of ACL-injured patients remains ambiguous. The purpose of this study was to assess the impact of LMPR tears on anteroposterior and rotatory knee laxity employing a clinically validated quantitative pivot shift (QPS) analysis system.
Patients with ACL injury recruited in a prospective ACL registry spanning from 2012 to 2020 were retrospectively screened for eligibility. Criteria for inclusion encompassed complete primary ACL tears, absence of concurrent ligamentous or osseous injuries requiring operative treatment, and no prior knee surgeries. Patients were assigned to two cohorts based on the presence (LMPR+) or absence (LMPR-) of an LMPR tear concomitant with ACL injury. Each patient underwent a standardized PS test, measurement of anterior tibial translation (ATT) (mm) using the Rolimeter, and QPS (mm) with a tablet-based image analysis system (PIVOT App). Comparative analyses of categorical variables were performed using the Fisher exact and Chi-square tests, while non-normally distributed continuous variables were compared between groups with the Mann-Whitney U test. Alfa was set at 0.05.
A total of 99 patients were included in the study, of which 22 were assigned to the LMPR+ and 77 to the LMPR- group. Tear depth was considered partial in 13 (59%) patients and full in 9 (41%) patients. The prevalence of medial meniscus tears was greater in the LMPR+ (n = 16, 73%) compared with the LMPR- (n = 33, 43%) group (p = 0.01). No difference was observed in ATT measured with the Rolimeter (p = 0.63). Similarly, no difference was found in QPS between the LMPR+ (2.3 mm) and the LMPR- (1.9 mm) group (p = 0.08).
Utilizing QPS in this investigation, LMPR tears do not significantly increase ATT or rotatory knee laxity. Consequently, although repairing LMRT associated with ACL injuries may be advisable for minimizing joint stress, their impact on controlling the PS in patients remains uncertain.
III, retrospective comparative study.
体外进行的生物力学研究已阐明外侧半月板后根（LMPR）撕裂对前交叉韧带（ACL）损伤膝关节的膝关节接触压力的有害影响。然而，LMPR撕裂对ACL损伤患者运动学的影响仍不明确。本研究的目的是采用经过临床验证的定量轴移（QPS）分析系统评估LMPR撕裂对膝关节前后向和旋转松弛度的影响。
对2012年至2020年前瞻性ACL登记处招募的ACL损伤患者进行回顾性筛选以确定其是否符合条件。纳入标准包括原发性ACL完全撕裂、不存在需要手术治疗的并发韧带或骨性损伤以及既往无膝关节手术史。根据ACL损伤时是否存在LMPR撕裂（LMPR+）或不存在（LMPR-）将患者分为两个队列。每位患者均接受标准化的轴移试验、使用旋转计测量胫骨前移（ATT）（mm）以及使用基于平板电脑的图像分析系统（PIVOT App）测量QPS（mm）。分类变量的比较分析采用Fisher精确检验和卡方检验，而非正态分布的连续变量在组间采用Mann-Whitney U检验进行比较。α设定为0.05。
本研究共纳入99例患者，其中22例被分配至LMPR+组，77例被分配至LMPR-组。13例（59%）患者的撕裂深度为部分撕裂，9例（41%）患者为完全撕裂。与LMPR-组（n = 33，43%）相比，LMPR+组（n = 16，73%）内侧半月板撕裂的患病率更高（p = 0.01）。使用旋转计测量的ATT无差异（p = 0.63）。同样，LMPR+组（2.3 mm）和LMPR-组（1.9 mm）之间的QPS也无差异（p = 0.08）。
在本研究中使用QPS，LMPR撕裂不会显著增加ATT或膝关节旋转松弛度。因此，尽管修复与ACL损伤相关联的LMPR撕裂对于最小化关节应力可能是可取的，但其对控制患者轴移的影响仍不确定。
III级，回顾性比较研究。
