Yonsei University College of Medicine, Seoul, Republic of Korea.
Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
PLoS One. 2024 Sep 17;19(9):e0310428. doi: 10.1371/journal.pone.0310428. eCollection 2024.
Accurate assessment of anterior cruciate ligament (ACL) function is vital for guiding treatment. Nevertheless, the presence of tibial subluxation in the neutral position of a patient with an ACL injury may potentially introduce a confounding factor. This study aims to investigate whether tibial subluxation in the neutral position affects the diagnosis of anterior instability in patients with ACL injuries, potentially impacting the reliability and diagnostic accuracy of stress radiography.
This study included 88 patients: 30 with acute complete ACL tears (acute group), 28 with chronic complete ACL tears (chronic group), and 30 patients who underwent knee arthroscopic surgery other than ACL reconstruction (control group). Side-to-side differences (SSD) in stress radiography were measured using the Telos load status and the SSD of the gap between the Telos load and unload statuses. Diagnostic accuracy of the two methods was assessed using areas under the receiver operating characteristic curves (AUCs).
The load SSD (5.92 ± 5.28 mm) was higher than the load-unload SSD (4.27 ± 5.99 mm) in the chronic group (P = 0.017). The load SSD demonstrated a significantly higher diagnostic value than that of the load-unload SSD in the combined group (AUC = 0.920 vs. 0.830; P = 0.012) and chronic group (AUC = 0.913 vs. 0.754; P = 0.002). After adjusting the symptoms for radiographic duration from 6 to 3 months in the chronic group, the load SSD exhibited a significantly higher diagnostic value (AUC = 0.902) than that of the load-unload SSD (AUC = 0.740; P < 0.001).
The load SSD provides superior diagnostic accuracy compared to the load-unload SSD in ACL tear cases, where static anterior tibial subluxation may result in false negatives. Although load-unload SSD may have diagnostic value within the first 3 months post-injury, the load SSD method provides a reliable assessment of ACL function for patients beyond this timeframe.
准确评估前交叉韧带（ACL）的功能对于指导治疗至关重要。然而，ACL 损伤患者中立位胫骨半脱位的存在可能会引入一个混杂因素。本研究旨在探讨胫骨中立位半脱位是否会影响 ACL 损伤患者前向不稳定的诊断，从而影响应力放射学的可靠性和诊断准确性。
本研究纳入 88 例患者：30 例急性完全 ACL 撕裂（急性组）、28 例慢性完全 ACL 撕裂（慢性组）和 30 例接受膝关节镜检查但非 ACL 重建的患者（对照组）。使用 Telos 负荷状态和 Telos 加载与卸载状态之间的间隙的 SSD 测量应力放射学中的侧-侧差异（SSD）。使用受试者工作特征曲线下面积（AUC）评估两种方法的诊断准确性。
慢性组的加载 SSD（5.92±5.28mm）高于加载-卸载 SSD（4.27±5.99mm）（P=0.017）。在联合组（AUC=0.920 对 0.830；P=0.012）和慢性组（AUC=0.913 对 0.754；P=0.002）中，加载 SSD 的诊断价值明显高于加载-卸载 SSD。在慢性组中，将症状与影像学持续时间从 6 个月调整为 3 个月后，加载 SSD 的诊断价值显著高于加载-卸载 SSD（AUC=0.902 对 0.740；P<0.001）。
在 ACL 撕裂病例中，加载 SSD 比加载-卸载 SSD 提供更高的诊断准确性，因为静态胫骨前半脱位可能导致假阴性。尽管加载-卸载 SSD 在受伤后前 3 个月内可能具有诊断价值，但加载 SSD 方法为受伤后超过此时间段的患者提供了 ACL 功能的可靠评估。
