ACL损伤膝关节中与斜坡病变相关的后内侧几何参数
简介
该研究评估了ACL损伤膝关节后内侧几何参数与ramp lesion的关系。回顾性纳入182例初次ACL重建患者（ramp lesion阳性63例，阴性119例），术前均行全长X线片、标准化膝关节MRI及关节镜确认。测量指标包括冠状位力线、胫骨后倾角（LTS、MTS）、内侧半月板倾斜角（MMS）、后内侧半月板楔角（PMMWA-A、PMMWA-S）、后内侧半月板…
英文摘要
BACKGROUND: The relationship between posteromedial knee geometry and ramp lesions is not fully defined. This study evaluated whether established radiologic measurements and additional posteromedial geometric parameters are associated with ramp lesion presence in ACL-injured knees. METHODS: Patients who underwent primary ACL reconstruction were retrospectively reviewed. Adults with preoperative long-leg radiographs, standardized knee MRI, and arthroscopic confirmation of ramp status were included; those with BMI ≥30 kg/m2, prior ipsilateral surgery, revision ACL reconstruction, multiligament injury, periarticular fracture, advanced osteoarthritis or inflammatory arthropathy, meniscal root tear, displaced meniscal tear, or inadequate MRI were excluded. Coronal alignment, lateral tibial slope (LTS), medial tibial slope (MTS), medial meniscal slope (MMS), posterior medial meniscal wedge angle-anterior (PMMWA-A), posterior medial meniscal wedge angle-superior (PMMWA-S), posterior medial meniscal vertical height (PMMVH), and posterior medial meniscal posterior offset-inferior (PMMPO-I) were measured. Group comparisons, point-biserial correlations, multivariable logistic regression, and reliability analyses were performed. RESULTS: A total of 203 patients were evaluated and 182 were included (63 ramp-positive, 119 ramp-negative). Pivot-shift grade and medial tibial plateau bone bruise differed between groups. Ramp-positive knees showed greater MMS, PMMWA-A, PMMWA-S, PMMVH, and PMMPO-I, whereas coronal alignment, LTS, and MTS did not differ. PMMPO-I showed the strongest correlation with ramp lesion presence (r = 0.556, p < 0.001). In the combined multivariable model, PMMPO-I and MMS remained independently associated with ramp lesions. CONCLUSIONS: Ramp lesion presence in ACL-injured knees was associated with selected posteromedial geometric parameters on MRI. After adjustment, PMMPO-I and MMS remained independently associated with ramp lesion presence and may aid MRI-based detection.