PDF(Pubmed)
Abstract：
OBJECTIVE: The impact of posterolateral tibial plateau impaction fractures (TPIF) on posttraumatic knee stability in the setting of primary anterior cruciate ligament (ACL) tear is unknown. The main objective was to determine whether increased bone loss of the posterolateral tibial plateau is associated with residual rotational instability and impaired functional outcome after ACL reconstruction.
METHODS: A cohort was identified in a prospective enrolled study of patients suffering acute ACL injury who underwent preoperative standard radiographic diagnostics and clinical evaluation. Patients were included when scheduled for isolated single-bundle hamstring autograft ACL reconstruction. Exclusion criteria were concurrent anterolateral complex (ALC) reconstruction (anterolateral tenodesis), previous surgery or symptoms in the affected knee, partial ACL tear, multi-ligament injury with an indication for additional surgical intervention, and extensive cartilage wear. On MRI, bony (TPIF, tibial plateau, and femoral condyle morphology) and ligament status (ALC, concomitant collateral ligament, and meniscus injuries) were assessed by a musculoskeletal radiologist. Clinical evaluation consisted of KT-1000, pivot-shift, and Lachman testing, as well as Tegner activity and IKDC scores.
RESULTS: Fifty-eight patients were included with a minimum follow-up of 12 months. TPIF was identified in 85% of ACL injuries (n = 49). The ALC was found to be injured in 31 of 58 (53.4%) cases. Pearson analysis showed a positive correlation between TPIF and the degree of concomitant ALC injury (p < 0.001). Multiple regression analysis revealed an increased association of high-grade TPIF with increased lateral tibial convexity (p = 0.010). The high-grade TPIF group showed worse postoperative Tegner scores 12 months postoperatively (p = 0.035).
CONCLUSIONS: Higher degrees of TPIFs are suggestive of a combined ACL/ALC injury. Moreover, patients with increased posterolateral tibial plateau bone loss showed lower Tegner activity scores 12 months after ACL reconstruction.
METHODS: III.
METHODS: A cohort was identified in a prospective enrolled study of patients suffering acute ACL injury who underwent preoperative standard radiographic diagnostics and clinical evaluation. Patients were included when scheduled for isolated single-bundle hamstring autograft ACL reconstruction. Exclusion criteria were concurrent anterolateral complex (ALC) reconstruction (anterolateral tenodesis), previous surgery or symptoms in the affected knee, partial ACL tear, multi-ligament injury with an indication for additional surgical intervention, and extensive cartilage wear. On MRI, bony (TPIF, tibial plateau, and femoral condyle morphology) and ligament status (ALC, concomitant collateral ligament, and meniscus injuries) were assessed by a musculoskeletal radiologist. Clinical evaluation consisted of KT-1000, pivot-shift, and Lachman testing, as well as Tegner activity and IKDC scores.
RESULTS: Fifty-eight patients were included with a minimum follow-up of 12 months. TPIF was identified in 85% of ACL injuries (n = 49). The ALC was found to be injured in 31 of 58 (53.4%) cases. Pearson analysis showed a positive correlation between TPIF and the degree of concomitant ALC injury (p < 0.001). Multiple regression analysis revealed an increased association of high-grade TPIF with increased lateral tibial convexity (p = 0.010). The high-grade TPIF group showed worse postoperative Tegner scores 12 months postoperatively (p = 0.035).
CONCLUSIONS: Higher degrees of TPIFs are suggestive of a combined ACL/ALC injury. Moreover, patients with increased posterolateral tibial plateau bone loss showed lower Tegner activity scores 12 months after ACL reconstruction.
METHODS: III.
摘要：
目的：胫骨平台后外侧嵌塞骨折（TPIF）对原发性前交叉韧带（ACL）撕裂的创伤后膝关节稳定性的影响尚不清楚。主要目的是确定胫骨平台后外侧骨丢失的增加是否与ACL重建后的残余旋转不稳定和功能结局受损有关。
方法：在一项对急性ACL损伤患者进行术前标准影像学诊断和临床评估的前瞻性研究中，确定了一个队列。计划进行隔离的单束绳肌腱自体ACL重建时，包括患者。排除标准是并发前外侧复合体（ALC）重建（前外侧肌腱固定术），以前的手术或受影响的膝盖的症状，ACL部分撕裂,多韧带损伤，有额外手术干预的指征，和广泛的软骨磨损。核磁共振成像,骨（TPIF，胫骨平台,和股骨髁形态）和韧带状态（ALC，伴随副韧带,和半月板损伤）由肌肉骨骼放射科医生评估。临床评估包括KT-1000，枢轴移位，还有拉赫曼测试,以及Tegner活动和IKDC得分。
结果：58例患者被纳入，至少随访12个月。TPIF在85％的ACL损伤中被确定（n=49）。在58例中的31例（53.4％）中发现ALC受伤。Pearson分析显示TPIF与伴随ALC损伤程度呈正相关(p<0.001)。多元回归分析显示，高级别TPIF与胫骨外侧凸度增加的相关性增加（p=0.010）。高级别TPIF组术后12个月Tegner评分较差（p=0.035）。
结论：高程度的TPIF提示ACL/ALC联合损伤。此外，胫骨平台后外侧骨丢失增加的患者在ACL重建后12个月表现出更低的Tegner活动评分.
方法：III.
方法：在一项对急性ACL损伤患者进行术前标准影像学诊断和临床评估的前瞻性研究中，确定了一个队列。计划进行隔离的单束绳肌腱自体ACL重建时，包括患者。排除标准是并发前外侧复合体（ALC）重建（前外侧肌腱固定术），以前的手术或受影响的膝盖的症状，ACL部分撕裂,多韧带损伤，有额外手术干预的指征，和广泛的软骨磨损。核磁共振成像,骨（TPIF，胫骨平台,和股骨髁形态）和韧带状态（ALC，伴随副韧带,和半月板损伤）由肌肉骨骼放射科医生评估。临床评估包括KT-1000，枢轴移位，还有拉赫曼测试,以及Tegner活动和IKDC得分。
结果：58例患者被纳入，至少随访12个月。TPIF在85％的ACL损伤中被确定（n=49）。在58例中的31例（53.4％）中发现ALC受伤。Pearson分析显示TPIF与伴随ALC损伤程度呈正相关(p<0.001)。多元回归分析显示，高级别TPIF与胫骨外侧凸度增加的相关性增加（p=0.010）。高级别TPIF组术后12个月Tegner评分较差（p=0.035）。
结论：高程度的TPIF提示ACL/ALC联合损伤。此外，胫骨平台后外侧骨丢失增加的患者在ACL重建后12个月表现出更低的Tegner活动评分.
方法：III.
