■在患有前交叉韧带(ACL)撕裂的成年人中,磁共振成像(MRI)扫描的骨瘀伤提供了对损伤的潜在机制的深入了解。很少有文献研究患有ACL眼泪的儿童的这些关系。
■检查并比较儿科患者接触和非接触ACL撕裂之间的骨瘀伤的数量和位置。
■队列研究;证据水平,3.
■在3个独立的机构中确定了在2018年至2022年期间接受ACL重建手术的男孩≤14岁和女孩≤12岁。合格标准要求在初次ACL撕裂后30天内详细记录损伤机制和MRI。先天性下肢异常患者,伴随骨折,后外侧角和/或后交叉韧带受伤,以前同侧膝盖受伤或手术,排除MRI扫描中明显的闭合性physes或闭合性physes.根据接触或非接触损伤机制将患者分为2组。使用脂肪抑制的T2加权图像和基于网格的胫骨股关节标测技术,对术前MRI扫描进行了回顾性审查,以确定冠状和矢状平面中是否存在骨瘀伤。
■共纳入109名患者,76例(69.7%)患者遭受非接触伤害,33例(30.3%)患者遭受接触伤害。接触组和非接触组之间的年龄没有显着差异(11.8±2.0vs12.4±1.3岁;P=.12),男性(90.9%vs88.2%;P>.99),从初次损伤到MRI的时间(10.3±8.1vs10.4±8.9天;P=.84),同时存在内侧半月板撕裂(18.2%vs14.5%;P=0.62)或外侧半月板撕裂(69.7%vs52.6%;P=0.097),和运动相关伤害(82.9%vs81.8%;P=.89)。胫骨外侧(股骨外侧髁+胫骨外侧平台)合并骨挫伤(87.9%接触vs78.9%非接触;P=.41)或胫骨内侧(股骨内侧髁[MFC]+胫骨内侧平台)合并骨挫伤(54.5%接触vs35.5%非接触;P=.064)。有接触性ACL撕裂的患者明显更有可能有位于中央的MFC瘀伤(赔率比,4.3;95%CI,1.6-11;P=.0038)并且在胫骨外侧平台的前部不太可能出现瘀伤(赔率比,0.27;95%CI,0.097-0.76;P=0.013)。
与持续非接触式ACL撕裂的儿童相比,在术前MRI扫描中,有接触式ACL撕裂的儿童出现中央位置MFC骨瘀伤的可能性要高出4倍。未来的研究应该调查这些骨挫伤模式与儿童接触ACL撕裂患者关节软骨损伤的潜在风险之间的关系。
UNASSIGNED: In adults with anterior cruciate ligament (ACL) tears, bone bruises on magnetic resonance imaging (MRI) scans provide insight into the underlying mechanism of injury. There is a paucity of literature that has investigated these relationships in children with ACL tears.
UNASSIGNED: To examine and compare the number and location of bone bruises between contact and noncontact ACL tears in pediatric patients.
UNASSIGNED: Cohort study; Level of evidence, 3.
UNASSIGNED: Boys ≤14 years and girls ≤12 years of age who underwent primary ACL reconstruction surgery between 2018 and 2022 were identified at 3 separate institutions. Eligibility criteria required detailed documentation of the mechanism of injury and MRI performed within 30 days of the initial ACL tear. Patients with congenital lower extremity abnormalities, concomitant fractures, injuries to the posterolateral corner and/or posterior cruciate ligament, previous ipsilateral knee injuries or surgeries, or closed physes evident on MRI scans were excluded. Patients were stratified into 2 groups based on a contact or noncontact mechanism of injury. Preoperative MRI scans were retrospectively reviewed for the presence of bone bruises in the coronal and sagittal planes using fat-suppressed T2-weighted images and a grid-based mapping technique of the tibiofemoral joint.
UNASSIGNED: A total of 109 patients were included, with 76 (69.7%) patients sustaining noncontact injuries and 33 (30.3%) patients sustaining contact injuries. There were no significant differences between the contact and noncontact groups in terms of age (11.8 ± 2.0 vs 12.4 ± 1.3 years; P = .12), male sex (90.9% vs 88.2%; P > .99), time from initial injury to MRI (10.3 ± 8.1 vs 10.4 ± 8.9 days; P = .84), the presence of a concomitant medial meniscus tear (18.2% vs 14.5%; P = .62) or lateral meniscus tear (69.7% vs 52.6%; P = .097), and sport-related injuries (82.9% vs 81.8%; P = .89). No significant differences were observed in the frequency of combined lateral tibiofemoral (lateral femoral condyle + lateral tibial plateau) bone bruises (87.9% contact vs 78.9% noncontact; P = .41) or combined medial tibiofemoral (medial femoral condyle [MFC] + medial tibial plateau) bone bruises (54.5% contact vs 35.5% noncontact; P = .064). Patients with contact ACL tears were significantly more likely to have centrally located MFC bruising (odds ratio, 4.3; 95% CI, 1.6-11; P = .0038) and less likely to have bruising on the anterior aspect of the lateral tibial plateau (odds ratio, 0.27; 95% CI, 0.097-0.76; P = .013).
UNASSIGNED: Children with contact ACL tears were 4 times more likely to present with centrally located MFC bone bruises on preoperative MRI scans compared with children who sustained noncontact ACL tears. Future studies should investigate the relationship between these bone bruise patterns and the potential risk of articular cartilage damage in pediatric patients with contact ACL tears.