Knee laxity, lateral meniscus tear and distal femur morphology influence pivot shift test grade in ACL injury patients
Knee laxity, lateral meniscus tear and distal femur morphology influence pivot shift test grade in ACL injury patients
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DOI：
10.1007/s00167-020-05994-7
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发表时间：
2020-04-17
影响因子：
3.8
通讯作者：
Koga, Hideyuki
中科院分区：
文献类型：
--
作者：
Cui, Weiding;Nakagawa, Yusuke;Koga, Hideyuki
目的虽然有多种因素被认为与前交叉韧带损伤患者的轴移试验分级有关，但关于哪些因素对轴移试验分级有影响还没有定论。本研究的目的是确定与术前轴移测试等级相关的因素。方法选择在本院接受前交叉韧带重建手术的患者366例。根据术前轴移试验分级(轻度：0~3级，重度：4~6级)分为两组。首先，采用单因素方差分析和卡方检验对13个自变量(年龄、性别、受伤至手术时间、过度伸展、KT测量、对侧枢轴移位试验分级、胫骨内侧和外侧倾斜度、外侧髁长度、外侧髁高度、股骨远端髁偏移量、内侧和外侧半月板撕裂)进行分析。然后根据单因素分析的结果进行二元Logistic回归分析(包括p<；0.2的自变量)。结果Logistic回归分析显示，过度伸展、半月板外侧撕裂、对侧枢椎移位试验分级、股骨远端髁部偏移量和KT测量值为术前枢椎移位分级的危险因素。结论过度伸展、半月板外侧撕裂、对侧枢椎移位试验分级、股骨远端髁部偏移量和前路不稳与术前枢椎移位分级有关。手术中不能改变上述因素的患者在进行前交叉韧带重建时可能需要特别考虑，因为术前较大的枢轴移位是前交叉韧带重建后残余枢轴移位的危险因素。
Purpose Although several factors have been considered to be associated with pivot shift test grade in ACL injured patients, a conclusion regarding which factors contribute to the pivot shift test grade has not been reached. The purpose of this study was to identify factors associated with preoperative pivot shift test grade. Methods Three hundred and sixty-six consecutive patients who underwent ACL reconstruction in our hospital were enrolled in the study. Patients were divided into two groups on the basis of preoperative pivot shift test grade (Mild: grade 0-3, Severe: grade 4-6). First, 13 independent variables (age, gender, period from injury to surgery, hyperextension, KT measurement, contralateral side pivot shift test grade, medial and lateral tibial slope, lateral condyle length, lateral condyle height, distal femoral condyle offset, medial and lateral meniscus tear) were analyzed by one-way ANOVA and Chi-squared test. Binary Logistic regression was then performed based on the results of univariate analyses (independent variables ofp < 0.2 were included). Results Hyperextension, lateral meniscus tear, contralateral side pivot shift test grade, distal femoral condyle offset and KT measurement were identified as risk factors for preoperative pivot shift grade via logistic regression analysis. Conclusion The current study revealed that hyperextension, lateral meniscus tear, contralateral side pivot shift test grade, distal femoral condyle offset and anterior instability were associated with preoperative pivot shift grade. Patients with above factors that cannot be modified during surgery may need special consideration when ACL reconstruction is performed, as greater preoperative pivot shift has been proven to be a risk factor for residual pivot shift after ACL reconstruction.