较小的切迹宽度指数、更陡峭的胫骨内、外侧斜率以及更高的外侧/内侧胫骨斜率比是骨骼未成熟患者前交叉韧带损伤的相关膝关节形态学因素——一项系统评价。
A small notch width index, steeper medial and lateral tibial slope and higher lateral/medial tibial slope ratio are relevant knee morphological factors for ACL injuries in skeletally immature patients-A systematic review.
作者信息
Voskuilen Robin, Dietvorst Martijn, van der Steen Marieke, Janssen Rob P A
机构信息
Department of Orthopaedic Surgery & Trauma Máxima Medical Center Eindhoven the Netherlands.
Department of Orthopaedic Surgery & Trauma Catharina Hospital Eindhoven Eindhoven the Netherlands.
出版信息
J Exp Orthop. 2025 Mar 22;12(1):e70211. doi: 10.1002/jeo2.70211. eCollection 2025 Jan.
PURPOSE
The incidence of anterior cruciate ligament (ACL) injuries in skeletally immature patients has drastically increased over the last decades. Morphology of the knee might play an important role. This literature review provides a systematic overview of knee morphological factors relevant to ACL injury in skeletally immature patients. The hypothesis of the present study is that multiple knee morphological parameters-such as a steep medial and lateral tibial slope (MTS and LTS) and a narrow intercondylar notch-can be identified as potentially relevant factors for ACL injury in this population.
METHODS
Systematic review according to PRISMA guidelines. MEDLINE, Embase and Cochrane were searched in December 2023 for studies reporting on knee morphology and ACL injury in skeletally immatures. The following inclusion criteria were used: English/Dutch studies, full-text available, human studies and skeletally immature patients. Parameters with clinical homogeneity and presented in two or more studies as means with standard deviation were included in a meta-analysis using RevMan. Parameters that could not be included in the meta-analyses were presented in a descriptive manner.
RESULTS
After screening 1825 studies, a total of 18 studies were included, of which 16 studies had parameters included in the meta-analyses. These studies investigated 31 knee morphological factors for ACL injury in skeletally immatures. Meta-analyses identified a smaller notch width index (NWI) (0.25 vs. 0.26, mean difference: -0.02 95% confidence interval [CI]: -0.03 to -0.01, ≤ 0.00001) steeper MTS and LTS (4.8° vs. 3.6° (mean difference: 0.55° 95% CI: 0.09-1.01, = 0.02) and 4.3° vs 2.8° (mean difference: 2.04° 95% CI: 0.75-3.32, = 0.0003), respectively) and higher LTS/MTS ratio as risk factors for ACL injury in skeletally immature patients.
CONCLUSIONS
A small NWI, steeper MTS and LTS and higher LTS/MTS ratios were identified as relevant knee morphological factors for ACL injuries in skeletally immature patients.
LEVEL OF EVIDENCE
Level III.
目的
在过去几十年中，骨骼未成熟患者前交叉韧带（ACL）损伤的发生率急剧上升。膝关节形态可能起重要作用。本文献综述系统概述了与骨骼未成熟患者ACL损伤相关的膝关节形态学因素。本研究的假设是，多个膝关节形态学参数，如陡峭的内侧和外侧胫骨坡度（MTS和LTS）以及狭窄的髁间切迹，可被确定为该人群ACL损伤的潜在相关因素。
方法
根据PRISMA指南进行系统综述。2023年12月检索MEDLINE、Embase和Cochrane数据库，查找关于骨骼未成熟患者膝关节形态和ACL损伤的研究。采用以下纳入标准：英文/荷兰文研究、有全文、人体研究以及骨骼未成熟患者。具有临床同质性且在两项或更多研究中以均值和标准差形式呈现的参数，使用RevMan进行荟萃分析。无法纳入荟萃分析的参数以描述性方式呈现。
结果
在筛选1825项研究后，共纳入18项研究，其中16项研究的参数纳入了荟萃分析。这些研究调查了31个与骨骼未成熟患者ACL损伤相关的膝关节形态学因素。荟萃分析确定较小的切迹宽度指数（NWI）（0.25对0.26，平均差值：-0.02，95%置信区间[CI]：-0.03至-0.01，≤0.00001）、更陡峭的MTS和LTS（分别为4.8°对3.6°（平均差值：0.55°，95%CI：0.09 - 1.01，P = 0.02）和4.3°对2.8°（平均差值：2.04°，95%CI：0.75 - 3.32，P = 0.0003））以及更高的LTS/MTS比值是骨骼未成熟患者ACL损伤的危险因素。
结论
较小的NWI、更陡峭的MTS和LTS以及更高的LTS/MTS比值被确定为骨骼未成熟患者ACL损伤的相关膝关节形态学因素。
证据水平
三级。
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