Tollefson Luke V, Otremba Jace R, Knowlan Claire J, Kennedy Nicholas I, Larson Christopher M, LaPrade Christopher M, LaPrade Robert F
Twin Cities Orthopedics, Edina, Minnesota, USA.
University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA.
Am J Sports Med. 2025 Feb;53(2):343-349. doi: 10.1177/03635465241303158. Epub 2025 Jan 4.
BACKGROUND: Anterior cruciate ligament (ACL) stress techniques-including single-leg stress radiographs, Telos, and KT-1000 arthrometer-are highly accessible and can provide additional diagnostic information to assess ACL and ACL graft integrity. The degree of anterior tibial translation (ATT) may be useful in guiding treatment when a diagnosis on magnetic resonance imaging is not conclusive or for judging if additional treatments, such as anterolateral complex augmentation, may be necessary. PURPOSE/HYPOTHESIS: The purpose of this study was to evaluate the effect of increasing posterior tibial slope (PTS) on baseline tibial position (BTP) and side-to-side differences (SSD) in ATT. A secondary purpose was to perform a subgroup analysis of SSD in ATT for patients with a PTS of ≥12° versus <12°, as well as for acute (<6 weeks from injury) versus chronic (≥6 weeks from injury or ACL graft tear) ACL tears. It was hypothesized that the BTP in normal intact knees would increase linearly with the PTS and there would be an increased SSD in ATT when comparing ACL-injured and ACL-intact knees. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Bilateral ACL stress radiographs were assessed from patients with primary ACL and ACL graft tears between March 2023 and March 2024. Bilateral stress views were obtained by single-leg full-length lateral weightbearing radiograph in 20° of knee flexion. The BTP and ATT were measured using a perpendicular line drawn between the posterior position of the lateral femoral condyle and the lateral tibial plateau. PTS measurements were assessed by the anatomic tibial axis. Statistical analysis using linear regression- > 0.6 was considered strong, between 0.4 and 0.6 moderate, and < 0.4 weak-and tests were used to compare the PTS with BTP and SSD in ATT. RESULTS: A total of 72 patients were analyzed using ACL stress radiographs. The results found a significant positive correlation between increased PTS and increased BTP for the ACL-intact knees ( < .001; = 0.476). A significant increase was found in the SSD in ATT of 1.73 mm with a positive correlation between increased PTS and increased SSD in ATT of ACL-deficient knees ( < .001; = 0.397). A subgroup analysis reported significant increases in SSD in ATT for both ACL-injured knees with a PTS ≥12° ( = .008) and for chronic ACL tears ( < .001) and no significant differences in SSD in ATT for ACL-injured knees with a PTS of <12° ( = .650) and for acute ACL tears ( = .745). CONCLUSION: This study found a significant positive correlation between PTS and the BTP in ACL-intact knees and for the SSD in ATT between ACL-injured and ACL-intact knees. Moreover, the SSD in ATT was significantly increased for ACL-injured knees with a PTS of ≥12° and for chronic ACL tears. No significant difference in SSD in ATT was found for ACL-injured knees with a PTS of <12° and for acute ACL tears.
背景：前交叉韧带（ACL）应力技术，包括单腿应力X线片、Telos和KT-1000关节测量仪，应用广泛，可为评估ACL及ACL移植物完整性提供额外的诊断信息。当磁共振成像诊断不明确时，胫骨前移（ATT）程度可能有助于指导治疗，或判断是否需要进行其他治疗，如增强外侧复合体。 目的/假设：本研究的目的是评估增加胫骨后倾坡度（PTS）对基线胫骨位置（BTP）和ATT左右侧差异（SSD）的影响。第二个目的是对PTS≥12°与＜12°的患者，以及急性（受伤＜6周）与慢性（受伤≥6周或ACL移植物撕裂）ACL撕裂患者的ATT的SSD进行亚组分析。假设正常完整膝关节的BTP会随PTS呈线性增加，且比较ACL损伤和ACL完整的膝关节时，ATT的SSD会增加。 研究设计：病例对照研究；证据等级，3级。 方法：对2023年3月至2024年3月期间原发性ACL和ACL移植物撕裂患者的双侧ACL应力X线片进行评估。通过在膝关节屈曲20°时单腿全长负重侧位X线片获得双侧应力位片。使用在外侧股骨髁后位与外侧胫骨平台之间绘制的垂线测量BTP和ATT。通过解剖学胫骨轴线评估PTS测量值。使用线性回归进行统计分析（相关系数＞0.6为强相关，0.4至0.6为中度相关，＜0.4为弱相关），并使用检验比较PTS与BTP以及ATT的SSD。 结果：共对72例患者的ACL应力X线片进行了分析。结果发现，ACL完整膝关节中，PTS增加与BTP增加之间存在显著正相关（P＜.001；r = 0.476）。ACL缺陷膝关节中，ATT的SSD显著增加1.73 mm，PTS增加与ATT的SSD增加之间存在正相关（P＜.001；r = 0.397）。亚组分析报告，PTS≥12°的ACL损伤膝关节（P =.008）和慢性ACL撕裂（P＜.001）的ATT的SSD显著增加，而PTS＜12°的ACL损伤膝关节（P =.650）和急性ACL撕裂（P =.745）的ATT的SSD无显著差异。 结论：本研究发现，ACL完整膝关节中PTS与BTP之间，以及ACL损伤和ACL完整膝关节之间ATT的SSD存在显著正相关。此外，PTS≥12°的ACL损伤膝关节和慢性ACL撕裂的ATT的SSD显著增加。PTS＜12°的ACL损伤膝关节和急性ACL撕裂的ATT的SSD无显著差异。
Knee Surg Sports Traumatol Arthrosc. 2022-7
Knee Surg Sports Traumatol Arthrosc. 2022-5
Cochrane Database Syst Rev. 2017-12-15
Zotero 插件