Lateral femoral tunnel preparation and graft fixation for anterior cruciate ligament reconstruction–A discussion

This article provides a discussion and commentary around the recent advances in arthroscopic anterior cruciate ligament reconstruction(ACLR),with a focus on the aspects of lateral femoral tunnel preparation and graft fixation techniques.The paper explores and comments on a recently published review by Dai et al,titled"Research progress on preparation of lateral femoral tunnel and graft fixation in ACLR",while providing insight into its relevance within the field of ACLR,and recommendations for future research.

Effect of suspension training on neuromuscular function, postural control, and knee kinematics in anterior cruciate ligament reconstruction patients

BACKGROUND Suspension training(SET)is a method of neuromuscular training that enables the body to carry out active training under unstable support through a suspension therapy system.However,there have been few reports in the literature on the application of SET to anterior cruciate ligament reconstruction(ACLR)patients.It is not clear what aspects of the patient's function are improved after SET.AIM To investigate the effect of SET on the neuromuscular function,postural control,and knee kinematics of patients after ACLR surgery.METHODS Forty participants were randomized to an SET group or a control group.The SET group subjects participated in a SET protocol over 6 wk.The control group subjects participated in a traditional training protocol over 6 wk.Isokinetic muscle strength of the quadriceps and hamstrings,static and dynamic posture stability test,and relative translation of the injured knee were assessed before and after training.RESULTS The relative peak torque of the quadriceps and hamstrings in both groups increased significantly(P<0.001),and the SET group increased by a higher percentage than those in the control group(quadriceps:P=0.004;hamstrings:P=0.011).After training,both groups showed significant improvements in static and dynamic posture stability(P<0.01),and the SET group had a greater change than the control group(P<0.05).No significant improvement on the relative translation of the injured knee was observed after training in either group(P>0.05).CONCLUSION Our findings show that SET promotes great responses in quadriceps and hamstring muscle strength and balance function in ACLR patients.

Five Strand Hamstring Tendon Autograft for Anterior Cruciate Ligament Reconstruction Provides No Benefit over the Gold Standard Four Strand Repair for Anterior Stability of the Knee: A Prospective Cohort Study

The Four-Strand Hamstring Tendon Autograft has been long established as the gold standard for surgical reconstruction of the Anterior Cruciate Ligament. Some studies have suggested wider grafts, such as a Five-Strand hamstring graft, may provide greater strength and a larger scaffold for incorporation of the graft into the bone tunnels, leading to greater postoperative anterior stability of the knee. 28 (n = 18 Four-Strand and n = 10 Five-Strand) patients with planned ACL reconstructive surgery by a single surgeon were recruited for this study. The KT-1000 Arthrometer (MED metric, CA, USA) was used to quantify AP translation in the subjects’ knees before (T0) and after surgery at 6 (T1) and 12 (T2) weeks. At 12 weeks there was significantly higher (p = 0.01) mean anterior laxity on Maximum Manual Test in the Five- Strand group (9.1 ± 1.7 mm) than the Four Strand Group (6.9 ± 2.3 mm). Further, there were significantly higher mean side-to-side differences (p = 0.01) on Maximum Manual Test in the Five-Strand cohort (5.1 ± 3.5 mm) compared to the Four-Strand cohort (1.9 ± 2.2 mm). A significantly larger positive mean change in anterior laxity (p = 0.02) from 6 - 12 weeks was evident in the Five-Strand group (1.4 ± 0.9) than the Four-Strand group (-0.3 ± 1.9 mm). No significant correlations were seen between graft widths and measures of anterior stability on KT-1000. This study illustrated that there was no benefit to using a Five-Strand Hamstring Tendon Autograft when compared to the gold standard Four-Strand Repair specifically with regards to anterior stability of the knee.

Biomechanics of the anterior cruciate ligament:Physiology,rupture and reconstruction techniques

The influences and mechanisms of the physiology,rupture and reconstruction of the anterior cruciate ligament(ACL)on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades.The knee is a complex joint with shifting contact points,pressures and axes that are affected when a ligament is injured.The ACL,as one of the intra-articular ligaments,has a strong influence on the resulting kinematics.Often,other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes.Knowing the surgical options,anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome.

Recurrent cyclops lesion after primary anterior cruciate ligament reconstruction using bone tendon bone allograft:A case report

BACKGROUND Cyclops lesions are a known complication of anterior cruciate ligament(ACL)reconstruction,with symptomatic cyclops syndrome occurring in up to 11%of surgeries.Recurrent cyclops lesions have been rarely documented;this case study documents the successful treatment of a recurrent cyclops lesion.CASE SUMMARY A 28-year-old female presented following a non-contact injury to the right knee.Workup and clinical exam revealed an ACL tear,and arthroscopic reconstruction was performed.Two years later a cyclops lesion was discovered and removed via arthroscopic synovectomy.Seven months postoperatively,the patient presented with pain,stiffness,and difficulty achieving terminal extension.A smaller recurrent cyclops lesion was diagnosed,and a repeat synovectomy was performed.The patient recovered fully.CONCLUSION To the best of our knowledge,this is the first documented case of recurrent cyclops lesion after bone-patellar tendon-bone allograft ACL reconstruction presenting as cyclops syndrome.

Current practice variations in the management of anterior cruciate ligament injuries in Croatia

AIM: To investigate current preferences and opinions on the diagnosis, treatment and rehabilitation of patients with anterior cruciate ligament(ACL) injury in Croatia. METHODS: The survey was conducted using a questionnaire which was sent by e-mail to all 189 members of the Croatian Orthopaedic and Traumatology Association. Only respondents who had performed at least one ACL reconstruction during 2011 were asked to fill out the questionnaire. RESULTS: Thirty nine surgeons responded to the survey. Nearly all participants(95%) used semitendinosus/gracilis tendon autograft for reconstruction and only 5% used bone-patellar tendon-bone autograft. No other graft type had been used. The accessory anteromedial portal was preferred over the transtibial approach(67% vs 33%). Suspensory fixation was the most common graft fixation method(62%) for the femoral side, followed by the cross-pin(33%) and bioabsorbable interference screw(5%). Almost all respondents(97%) used a bioabsorbable interference screw for tibial side graft fixation. CONCLUSION: The results show that ACL reconstruction surgery in Croatia is in step with the recommendations from latest world literature.

Anatomy of the anterolateral ligament of the knee joint

Despite remarkable improvements in clinical outcomes after anterior cruciate ligament reconstruction,the residual rotational instability of knee joints remains a major concern.The anterolateral ligament(ALL)has recently gained attention as a distinct ligamentous structure on the anterolateral aspect of the knee joint.Numerous studies investigated the anatomy,function,and biomechanics of ALL to establish its potential role as a stabilizer for anterolateral rotational instability.However,controversies regarding its existence,prevalence,and femoral and tibial insertions need to be addressed.According to a recent consensus,ALL exists as a distinct ligamentous structure on the anterolateral aspect of the knee joint,with some anatomic variations.The aim of this article was to review the updated anatomy of ALL and present the most accepted findings among the existing controversies.Generally,ALL originates slightly proximal and posterior to the lateral epicondyle of the distal femur and has an anteroinferior course toward the tibial insertion between the tip of the fibular head and Gerdy’s tubercle below the lateral tibial plateau.

Anterior cruciate ligament reconstruction using a double bundle hamstring autograft configuration in patients under 30 years

BACKGROUND Anterior cruciate ligament reconstruction(ACLR)has a high incidence of re-tear in younger patients.Despite comparable functional outcomes,the incidence of retear using single and double bundle ACLR methods has not been well reported.AIM To hypothesize that double bundle hamstring ACLR has a lower graft rupture rate compared with single bundle hamstring ACLR grafts in young patients.METHODS One hundred and twelve patients<30 years of age at the time of primary double bundle ACLR were eligible for study participation.91(81.3%)could be contacted,with a mean age of 20.4 years(range 13-29)and mean post-operative follow-up time of 59 mo(range 25-107).Telephone questionnaires evaluated the incidence(and timing)of subsequent re-tear and contralateral ACL tear,further surgeries,incidence and time to return to sport,and patient satisfaction.RESULTS Of the 91 patients,there were 6(6.6%,95%CI:1.4-11.7)ACL graft re-ruptures,with a mean time to re-rupture of 28 mo(range 12-84).Fourteen patients(15.4%)experienced a contralateral ACL rupture and 14 patients(15.4%)required further surgery to their ipsilateral knee.fifty patients(54.9%)returned to pre-injury level of sport.Of those<20 years(n=45),4 patients(8.9%,95%CI:0.4-17.3)experienced a re-rupture,with mean time to re-injury 15 mo(range 12-24).Comparative analysis with existing literature and revealed a non-significant Chisquared statistic of 2.348(P=0.125).CONCLUSION A trend existed toward lower graft rupture rates in young patients undergoing double bundle ACLR utilizing a hamstring autograft,compared with rates reported after single bundle ACLR.

Patellofemoral MRI Alterations Following Single Bundle ACL Reconstruction with Hamstring Autografts Are Associated with Quadriceps Femoris Atrophy

High incidence of patellofemoral pain and patellofemoral joint osteoarthritis was found following anterior cruciate ligament(ACL)reconstruction.The unstability of patellofemoral joint might be an important contribution factor.This study was designed to define the relationship between the unstability of patellofemoral joint and quadriceps femoris atrophy.Twenty patients underwent MRI scan before ACL reconstruction and every two weeks after surgery,until 12 weeks.The merchant’s patellar congruence angle,lateral inclination angle,and quadriceps femoris muscle cross-sectional area were measured and the relationship between the changes of angles and the ratio of quadriceps femoris atrophy was studied by multiple regression analysis.Significant quadriceps femoris atrophy was observed after ACL reconstruction during the follow-up period of 12 weeks.The merchant’s patellar congruence angle and lateral inclination angle significantly changed after surgery.The alterations of the merchant’s patellar congruence angle were significantly correlated with the atrophy ratio of vastus medialis(coefficient=-5.76)and vastus lateralis(coefficient=8.35)during the follow-up period of 12 weeks.The alterations of lateral inclination angle were significantly correlated with the atrophy ratio of vastus medialis(coefficient=20.62),vastus lateralis(coefficient=-11.38)and rectus femoris(coefficient=-0.469)during the follow-up period 12 weeks.To sum up,ACL reconstruction can alleviate the dysfunction of patellofemoral joint to a certain extent.But,the unbalanced atrophy of quadriceps femoris once again destroyed the stability of patellofemoral joint following the operation,which might be one cause of patellofemoral joint pain and early onset of osteoarthritis after ACL reconstruction.So,rehabilitation training that focuses on quadriceps femoris especially the vastus medialis shortly following operation is suggested.

Anterolateral complex of the knee: State of the art

Rotatory instability of the knee represents the main reason for failure and poor clinical outcomes regarding anterior cruciate ligament(ACL)reconstruction techniques.It is now clear that the anterolateral complex(ALC)of the knee possesses a fundamental role,in association with the ACL,in controlling internal rotation.Over the past decade,ever since the anterolateral ligament has been identified and described as a distinct structure,there has been a renewed interest in the scientific community about the whole ALC:Lateral extra-articular tenodesis have made a comeback in association with ACL reconstructions to improve functional outcomes,reducing the risks of graft failure and associated injuries.Modern ACL reconstruction surgery must therefore investigate residual instability and proceed,when necessary,to extra-articular techniques,whether functional tenodesis or anatomical reconstruction.This review aims to investigate the latest anatomical and histological descriptions,and the role in rotational control and knee biomechanics of the ALC and its components.The diagnostic tools for its identification,different reconstruction techniques,and possible surgical indications are described..In addition,clinical and functional results available in the literature are reported.

Overview of the anterolateral complex of the knee

In the last few years,much more information on the anterolateral complex of the knee has become available.It has now been demonstrated how it works in conjunction with the anterior cruciate ligament(ACL)controlling anterolateral rotatory laxity.Biomechanical studies have shown that the anterolateral complex(ALC)has a role as a secondary stabilizer to the ACL in opposing anterior tibial translation and internal tibial rotation.It is of utmost importance that surgeons comprehend the intricate anatomy of the entire anterolateral aspect of the knee.Although most studies have only focused on the anterolateral ligament(ALL),the ALC of the knee consists of a functional unit formed by the layers of the iliotibial band combined with the anterolateral joint capsule.Considerable interest has also been given to imaging evaluation using magnetic resonance and several studies have targeted the evaluation of the ALC in the setting of ACL injury.Results are inconsistent with a lack of association between magnetic resonance imaging evidence of injury and clinical findings.Isolated ACL reconstruction may not always reestablish knee rotatory stability in patients with associated ALC injury.In such cases,additional procedures,such as anterolateral reconstruction or lateral tenodesis,may be indicated.There are several techniques available for ALL reconstruction.Graft options include the iliotibial band,gracilis or semitendinosus tendon autograft,or allograft.

Posttraumatic incarceration of medial collateral ligament into knee joint with anterior cruciate ligament injury

Medial collateral ligament of the knee is an important coronal stabiliser and often injured in isolation or as combination of injuries. The article reports a case of incarcerated medial collateral ligament （MCL） injury in combination with anterior cruciate ligament （ACL） injury in 20 year old male who presented to us 4 weeks after injury. Clinical examination and MRI was correlated to complete ACL tear with torn distal MCL and incarceration into the joint. Patient was taken up for ACL hamstring graft reconstruction with mini-arthrotomy and repair of the torn MCL. Patient was followed up with dedicated rehabilitation protocol with good functional results. At one year follow-up, patient exhibited full range of motion with negative Lachman, Pivot shift and valgus stress tests. This article highlights the rare pattern of MCL tear and also reviews the literature on this pattern of injury.

Anterior cruciate ligament reconstruction in a 75 years old man： a case report with review of literature

Anterior cruciate ligament （ACL） reconstruction is usually recommended for young patients. Several recent articles have however reported comparable outcomes of ACL reconstruction between youth and patients in fourth or fifth age group. But in the literature there are not many reports about ACL reconstruction in patients over 70 years old. We report a case of a successful arthroscopic ACL reconstruction （using single bundle quadrupled hamstring graft） in an active 75-year-old medical practitioner. Successful outcome after ACL reconstruction can be achieved in selected older patients; chronological age is no barrier.

In vitro study of knee stability after two-band two-tunnel posterior cruciate ligament reconstruction

To compare the ability of three different reconstruction procedures in restoring the posterior displacement of tibia and the posterior stability of the knee joint from 0° to 120°flexion. Methods ： Three posterior cruciate ligaments （PCL） reconstruction procedures were performed, namely two-band two-tunnel reconstruction, one-band anterior tunnel reconstruction and one-band posterior tunnel reconstruction. The posterior displacement of the tibia in relation to the femur was measured when a 200N posterior force was applied. Results： Within the flexion range of 0° to 30°, the displacement in the one-band posterior tunnel reconstruction showed little difference from that of an intact knee （P〉0.05）. But when the flexion exceeded 30°, especially when it exceeded 60°, the displacement in oneband posterior tunnel reconstruction was much greater than that of an intact knee （P〈0.01）. In two-band two-tunnel reconstruction and one-band anterior tunnel reconstruction, the displacement was approximately the same as that of an intact knee ranging from 0° to 120° （P〉0.05）, while a slight over-restriction might be found at some angles. Conclusions： Two-band reconstruction could effectively restrict the posterior displacement of the tibia and restore anterior, posterior stability of the knee joint within its full range of flexion. One-band anterior tunnel reconstruction also could maintain the posterior stability of the knee, while the result of one-band posterior tunnel reconstruction is the most unsatisfactory.

肌内效贴对前交叉韧带重建后康复疗效的Meta分析

目的:一些研究显示肌内效贴在提升前交叉韧带重建后患者肌肉力量、改善关节稳定性、减轻疼痛及水肿方面具有积极效应,然而现有研究关于肌内效贴的临床疗效存在相互矛盾的结果。文章采用Meta分析方法,系统评价肌内效贴对前交叉韧带重建术后康复疗效的影响。方法:应用计算机检索PubMed、Web of Science、Embase、The Cochrane Library、EBSCO、中国知网、万方、维普数据库,搜集有关肌内效贴对前交叉韧带重建后患者影响的随机对照试验,检索时限均从各数据库建库至2022-12-06,结局指标包括股四头肌力量、腘绳肌力量、膝关节肿胀、膝关节活动度、Lysholm膝关节功能评分、目测类比评分6个连续型变量。运用EndNote X9.1筛选文献,采用Cochrane风险偏倚评估工具和Jadad量表评估纳入文献质量,采用RevMan 5.3软件进行Meta分析。结果:①共纳入6项随机对照试验,包括252例前交叉韧带重建后患者,其中对照组126例,肌内效贴组126例;②Meta分析结果显示,与对照组相比,肌内效贴组患者腘绳肌力量显著增加[SMD=0.68,95%CI(0.12,1.23),P=0.02]、目测类比评分显著降低[MD=-0.56,95%CI(-1.04,-0.08),P=0.02],两组患者间股四头肌力量、膝关节肿胀、膝关节活动度及Lysholm膝关节功能评分比较差异均无显著性意义(P>0.05)。结论:当前证据显示,肌内效贴可能有助于提升前交叉韧带重建后患者腘绳肌力量、减轻患者疼痛,然而并不能显著改善患者股四头肌力量、膝关节肿胀、膝关节活动度和功能评分。

运动疗法对前交叉韧带重建后康复疗效影响的网状Meta分析

目的:运动干预被认为是前交叉韧带重建后康复的基础。然而,关于何种运动疗法在改善前交叉韧带重建后患者膝关节肌肉力量和功能方面更有效,目前仍未得出明确结论。为此,文章采用网状Meta分析方法,比较运动疗法治疗前交叉韧带重建后的疗效,为选择最佳运动疗法提供循证医学依据。方法:计算机检索PubMed,Web of Science,Embase,The Cochrane Library及EBSCO数据库运动疗法治疗前交叉韧带重建后的随机对照试验,检索时限均从建库至2023-11-20。结局指标包括股四头肌肌力、腘绳肌肌力、膝关节功能评分3个连续性变量。运用EndNote X9.1软件筛选文献。采用Cochrane风险偏倚评估工具对纳入的文献进行质量评价,根据GRADE评分对文章结果的证据强度进行评级,采用Stata 16.0进行网状Meta分析。结果:①共纳入36项随机对照试验,包括1179例前交叉韧带重建后患者,纳入文献整体质量中等;涉及9种运动疗法:等速训练、交叉训练、离心训练、水中康复、血流限制训练、运动控制训练、增强式训练、全身振动训练和综合训练;对照措施为常规康复训练。②网状Meta分析结果显示:与常规康复训练相比,离心训练(SMD=2.08,95%CI:0.56-3.60,P=0.007)对前交叉韧带重建后患者股四头肌肌力的改善效果最佳,其次是综合训练(SMD=1.69,95%CI:0.11-3.27,P=0.249)和全身振动训练(SMD=0.81,95%CI:0.11-1.51,P=0.042);在提升患者腘绳肌肌力方面,综合训练(SMD=2.08,95%CI:0.30-3.86,P=0.022)效果最佳,其次是增强式训练(SMD=1.51,95%CI:0.18-2.84,P=0.026)和等速训练(SMD=1.37,95%CI:0.06-2.67,P=0.039);综合训练(SMD=4.60,95%CI:2.40-6.80,P<0.001)改善膝关节功能评分最有效,其次是离心训练(SMD=1.75,95%CI:0.24-3.25,P=0.023)和水中康复(SMD=1.65,95%CI:0.07-3.24,P=0.041)。结论:低到中等强度的临床证据证实,在改善前交叉韧带重建后患者膝关节肌肉力量和功能方面,综合训练可能是最有效的运动疗法,其次是离心训练、增强式训练、等速训练、全身振动训练、水中康复。未来仍需更多高质量的临床随机对照试验来验证结论的可靠性。

镜下前交叉韧带重建联合固定平台单髁置换术的早中期临床疗效观察

目的 探讨单髁置换手术(unicompartmental knee arthroplasty, UKA)联合前交叉韧带重建手术(anterior cruciate ligament reconstruction, ACLR)对单间室膝骨关节炎(unicompartmental knee osteoarthritis, UKOA)合并前交叉韧带缺失(anterior cruciate ligament deficient, ACLD)患者的早期临床疗效结果。方法 选取2018年1月至2022年6月广西中医药大学附属桂林市中医医院采用同期UKA联合ACLR治疗的UKOA合并ACLD的12例患者进行回顾性研究。评估术前和末次随访的VAS、IKDC、Lysholm评分,并随访观察并发症及翻修的发生情况。结果 所有患者随访6~55个月,平均随访(24.58±10.48)个月。所有患者的平均住院时间为(13.67±6.20)d,平均出血量为(43.33±39.44)mL,平均切口长度为(9.25±0.43)cm。末次随访时的VAS评分较术前明显降低(P<0.05);Lysholm评分平均为(67.17±22.96)分、IKDC评分平均为(59.87±8.77)分,分别较术前平均(51.33±14.99)分、(48.95±13.68)分明显提高(P<0.05)。结论 早中期的临床数据显示,同时进行ACLR联合UKA对UKOA合并ACLD手术治疗的临床疗效显著,可有效改善患者的膝关节不稳定和内侧间室疼痛,提高患者本体感觉,患者并发症发生率较低,值得临床推广应用,但应严格把握手术的适应证。

移植物类型对前交叉韧带重建后患者膝关节功能的影响

背景:临床上常采用移植物重建前交叉韧带,而不同移植物类型又影响着患者术后膝关节功能和康复方案的制定。目的:回顾分析不同移植物类型对前交叉韧带重建后患者肌力、关节稳定性、功能性活动及重返运动的影响。方法:在PubMed、Web of Science、Cochrane、中国知网、万方数据库中进行检索,中文检索词为“前交叉韧带重建术,自体移植物,同种异体移植物,人工韧带,骨-髌腱-骨,股四头肌肌腱,腘绳肌肌腱,腓骨长肌肌腱,康复训练,重返运动”;英文检索词为“anterior cruciate ligament reconstruction,autografts,allografts,artificial ligaments,bone-patellatendon-bone,quadriceps tendon autograft,hamstring tendon autograft,peroneus longus tendon autograft,rehabilitation,exercise,protocol,return to sport”。结果与结论:选用骨-髌腱-骨移植物的患者应加强股四头肌离心收缩练习,康复后期应关注股四头肌耐力和爆发力的恢复。与骨-髌腱-骨移植物和腘绳肌肌腱移植物相比,选用股四头肌肌腱移植物的患者在5-8个月内符合回归标准的患者明显更少,应制定较长时间的训练计划,训练周期尽量持续到3年以上。选用腘绳肌肌腱移植物应强化多角度下腘绳肌力量训练,尤其是屈膝60°以上的周期至少持续至术后18周。选用腓骨长肌肌腱移植物的患者后续应加强踝关节周围肌肉力量,以足底肌肉力量为主。选用同种异体移植物应注意移植物经低剂量辐射消毒后其抗张力性降低20%,因此应关注膝关节稳定性训练。选用人工韧带移植物的患者3-6周内可渐进性增强股四头肌和腘绳肌力量训练,重视早期本体感觉练习,对平衡、跳跃及灵活性进行针对性训练。

膝关节交叉韧带重建的思考与认识

膝关节交叉韧带是维持膝关节稳定性的主要结构,其中前交叉韧带(anterior cruciate ligament,ACL)具有限制胫骨过度前移、内旋、内外翻以及过伸等重要作用,而后交叉韧带(posterior cruciate ligament,PCL)则是限制胫骨过度后移的主要装置[1-2]。单纯膝关节交叉韧带损伤后如未得到及时诊治,由此导致的膝关节不稳将继发半月板及关节软骨等损伤,进一步加重关节内退变,表现为疼痛、关节交锁和关节不稳等症状[3-4]。

EOS双平面成像测量胫骨平台后倾角与前交叉韧带损伤的相关性研究

目的探讨基于三维成像的EOS系统评估胫骨平台后倾角(PTS)对前交叉韧带(ACL)损伤患者的预测价值,并与3种传统X线片测量方法进行对比。方法回顾分析南京大学医学院附属鼓楼医院2018年10月—2021年12月收治的51例术中确诊为ACL损伤(ACL损伤组)及34例非ACL损伤(对照组)患者的临床资料。通过EOS法、全长法、近端法和后皮质法对患者的PTS进行评估,通过logistic回归分析等统计学方法,探讨不同PTS测量方法对ACL损伤的预测特异性。结果应用EOS法、全长法和近端法测量ACL损伤组患者的PTS,并与对照组相比,差异有统计学意义(P<0.05),采用logistic回归分析并构建受试者工作特征(ROC)曲线,曲线下面积(AUC)EOS法(0.955)和全长法(0.657)均优于近端法(0.558)和后皮质法(0.484)。对照组和ACL损伤组EOS法和全长法的测量结果均具有相关性(r=0.612,r=0.641)。结论采用EOS系统和基于下肢全长侧位X线片的全长法测量PTS预测ACL损伤的易发性优于近端法和后皮质法,在没有EOS条件的医院,可以使用全长法评估患者的PTS。