The Influence of Meniscal and Anterolateral Capsular Injury on Knee Laxity in Patients With Anterior Cruciate Ligament Injuries
The Influence of Meniscal and Anterolateral Capsular Injury on Knee Laxity in Patients With Anterior Cruciate Ligament Injuries
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DOI：
10.1177/0363546516659649
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发表时间：
2016-12-01
影响因子：
4.8
通讯作者：
Irrgang, James J.
中科院分区：
文献类型：
--
作者：
Musahl, Volker;Rahnemai-Azar, Ata A.;Irrgang, James J.
背景：前外侧囊(ALC)对前交叉韧带(ACL)损伤患者定量旋转松弛的二次约束作用目前尚有争议。目的/假设：目的是确定合并ALC损伤以及其他软组织损伤对前交叉韧带损伤患者旋转膝关节松弛的影响。研究设计：横断面研究；证据水平；3.方法：41例前交叉韧带损伤患者(平均年龄23 6.9岁)。两位盲人肌肉骨骼放射科医生回顾了核磁共振成像(MRI)扫描，以确定是否存在前交叉韧带损伤和伴随的软组织损伤，包括ALC、内侧副韧带、外侧副韧带、后外侧角、内侧半月板和外侧半月板。在麻醉下进行标准化的轴移试验，并根据轴移动作时胫骨外侧室的前移来量化旋转松弛程度。数据分析采用t检验。P<；.05有统计学意义。结果：所有患者均证实前交叉韧带完全断裂。有21例(51%)患者观察到ALC损伤的MRI证据。有ALC损伤MRI证据的患者旋转膝关节松弛程度(3.6+/-1.5 mm)显著高于无ALC损伤的患者(2.7+/-1.5 mm；P=0.04)。外侧半月板损伤17例(41%)，内侧半月板损伤19例(46%)。有内侧半月板损伤或外侧半月板损伤的患者的膝关节旋转松弛程度明显高于无损伤的患者(内侧半月板：3.7±/-1.4 mm对2.7+/-1.6 mm；外侧半月板：3.7+/-1.7 mm对2.7+/-1.3 mm)(P=0.03)。结论：在前交叉韧带损伤的患者中，伴有ALC、内侧半月板或外侧半月板损伤的MRI证据与膝关节旋转松弛增加有关。这些结构可能在前交叉韧带损伤的膝关节中起到重要的二次稳定器的作用。对于这些二次稳定器的损伤应仔细评估并进行适当的治疗，特别是在膝关节轴位移位较高的情况下。
Background: The role of the anterolateral capsule (ALC) as a secondary restraint to quantitative rotatory laxity of patients with an anterior cruciate ligament (ACL) injury is currently debated.Purpose/Hypothesis: The purpose was to determine the influence of concomitant ALC injuries as well as injuries to other soft tissue structures on rotatory knee laxity in patients with an ACL injury. It was hypothesized that a concomitant ALC injury would be associated with increased rotatory knee laxity as measured during a quantitative pivot-shift test.Study Design: Cross-sectional study; Level of evidence, 3.Methods: Forty-one patients with an ACL injury (average age, 23 6.9 years) were enrolled. Two blinded musculoskeletal radiologists reviewed magnetic resonance imaging (MRI) scans for the presence of ACL injuries and concomitant soft tissue injuries including the ALC, medial collateral ligament, lateral collateral ligament, posterolateral corner, medial meniscus, and lateral meniscus. A standardized pivot-shift test was performed under anesthesia, and rotatory laxity was quantified according to anterior translation of the lateral tibial compartment during the pivot-shift maneuver. The Student t test was used to analyze the data. Statistical significance was set at P < .05.Results: A complete ACL rupture was confirmed in all of the patients. MRI evidence of an ALC injury was observed in 21 (51%) of the patients. Patients with MRI evidence of an ALC injury had significantly higher rotatory knee laxity (3.6 +/- 1.5 mm) compared with those without an ALC injury (2.7 +/- 1.5 mm; P = .04). Lateral and medial meniscus injuries were detected in 17 (41%) and 19 (46%) patients, respectively. Patients with MRI evidence of either a medial meniscus injury or lateral meniscus injury had significantly higher rotatory knee laxity compared with patients without these injuries (medial meniscus: 3.7 +/- 1.4 mm vs 2.7 +/- 1.6 mm, respectively; lateral meniscus: 3.7 +/- 1.7 mm vs 2.7 +/- 1.3 mm, respectively) (P = .03 for both).Conclusion: MRI evidence of a concomitant injury to the ALC, medial meniscus, or lateral meniscus is associated with increased knee rotatory laxity in patients with an ACL injury. These structures may function as important secondary stabilizers in an ACL-injured knee. Careful assessment and proper treatment of injuries to these secondary stabilizers should be considered, especially in knees with a high level of the pivot shift.