前十字韧带撕裂后的高度轴移与完全性外侧半月板后根部损伤的相关性

The association between high-grade pivot-shift and complete lateral meniscus posterior root tear after anterior cruciate ligament ruptures

目的探讨前十字韧带(anterior cruciate ligament,ACL)撕裂后的高度轴移与完全性外侧半月板后根部(lateral meniscus posterior root,LMPR)损伤的相关性。方法对2013年1月至2017年12月连续收治的ACL撕裂合并LMPR损伤患者86例进行回顾性分析,男66例,女20例;年龄(27.8±8.3)岁(范围16~49岁),体质指数(25.1±3.2)kg/m2(范围17.4~33.9 kg/m2),伤后时间(33.5±79.4)周(范围3 d^11年)。根据ACL重建术前麻醉下轴移试验结果将患者分为高度轴移组:国际膝关节评分委员会(International Knee Documentation Committee,IKDC)评级Ⅱ度和Ⅲ度,60例;低度轴移组,IKDC评级0度和Ⅰ度,26例。通过多元Logistic回归分析高度轴移的危险因素,自变量包括LMPR损伤程度、半月板股骨韧带完整性、半月板外突程度、KT-1000侧侧差值、年龄、性别及体质指数。结果完全性LMPR损伤患者在高度轴移组中所占比例高于低度轴移组,高度轴移与完全性LMPR损伤相关[OR=4.096,95%CI(1.339,12.371),P=0.013]和KT-1000侧侧差值增大[OR=9.632,95%CI(3.095,29.975),P<0.001];高度轴移与完全性LMPR损伤的相关性在伤后时间≥12周的患者中更加显著[OR=8.343,95%CI(1.224,56.853),P=0.030]。高度轴移与半月板股骨韧带完整性、半月板外突程度、年龄、性别及体质指数不相关(P>0.05)。结论在ACL撕裂患者中,完全性LMPR损伤是高度轴移的独立危险因素,尤其当伤后时间≥12周时。

Objective To investigate the association between high-grade pivot-shift and complete lateral meniscus posterior root(LMPR)tear in patients with anterior cruciate ligament(ACL)ruptures.Methods From January 2013 to December 2017,a total of 86 ACL injured patients with LMPR tears were reviewed retrospectively.There were 66 males and 20 females with an average age of 27.8±8.3 years(range 16-49 years)and an mean BMI of 25.1±3.2 kg/m2(range 17.4-33.9 kg/m2).The average duration from injury to surgery was 33.5±79.4 weeks(range 3 days to 11 years).All patients were classified into high-grade pivot-shift group(60 patients of IKDC grade II-III)and low-grade pivot-shift group(26 patients of IKDC grade 0-I)according to the results of pivot-shift tests under anesthesia before ACL reconstructions.Predictive factors of high-grade pivot-shift were analyzed by multivariable Logistic regression,involving degree of LMPR tear,integrity of meniscofemoral ligament,width of lateral meniscal extrusion,KT-1000 arthrometer side-to-side difference,age,sex,and BMI.Results The prevalence of complete LMPR tear in high-grade pivot-shift group was higher than that in low-grade pivot-shift group.High-grade pivot-shift was associated to complete LMPR tear[OR=4.096,95%CI(1.339,12.371),P=0.013]and KT-1000 arthrometer side-to-side difference[OR=9.632,95%CI(3.095,29.975),P<0.001].The association between high-grade pivot-shift and complete LMPR tear was more striking in patients with duration from injury to surgery≥12 weeks[OR=8.343,95%CI(1.224,56.853),P=0.030].High-grade pivot-shift did not associated with meniscofemoral ligament,lateral meniscal extrusion,age,sex and BMI(P>0.05).Conclusion In patients with ACL ruptures,complete LMPR tear was an independent risk factor of high-grade pivot-shift,especially for patients with 12 weeks at least duration from injury to surgery.