外侧胫骨后倾角增大及胫股旋转增加与前交叉韧带损伤中外侧半月板撕裂风险增高相关
简介
该回顾性研究纳入215例行一期ACL重建的患者，基于术前MRI测量胫骨后倾角和胫股旋转角，并与关节镜确认的外侧半月板撕裂进行多因素回归分析。结果显示外侧胫骨后倾角增大和胫股旋转角加大是外侧半月板撕裂的独立危险因素，其中胫股旋转角呈非线性关系、尤以内旋过度贡献最显著。上述参数有助于术前风险分层，但区分度有限，仍需外部验证。
英文摘要
BACKGROUND: Lateral meniscal (LM) tears are common in anterior cruciate ligament (ACL)-injured knees but may be underestimated on preoperative magnetic resonance imaging. Structural imaging parameters reflecting knee morphology and alignment may help identify patients at increased risk of LM injury. This study examined whether medial posterior tibial slope (MPTS), lateral posterior tibial slope (LPTS), and tibiofemoral rotation angle (TFA) are associated with LM tears in ACL injuries. METHODS: This retrospective cohort study evaluated clinical records and preoperative magnetic resonance imaging (MRI) scans of patients undergoing primary ACL reconstruction. MPTS, LPTS, TFA, and delta angle were measured on standardized MRI, and LM status was confirmed arthroscopically. Multivariable logistic regression analysis identified independent associations. Restricted cubic spline (RCS) analysis assessed nonlinear dose-response patterns, and receiver operating characteristic (ROC) curves with DeLong testing quantified incremental predictive performance. RESULTS: A total of 215 patients were included (100 with and 115 without LM tears). Patients with tears demonstrated greater LPTS (5.9 ± 3.9° vs 4.5 ± 3.4°, p = 0.005) and TFA (2.3 ± 4.7° vs 1.0 ± 3.1°, p = 0.015), while MPTS and delta angle did not differ. After adjustment, LPTS (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.03-1.21; p = 0.007), MPTS (OR, 2.48; 95% CI, 1.24-5.07; p = 0.011), and TFA (OR, 1.10; 95% CI, 1.02-1.18; p = 0.014) remained independently associated with LM tears. RCS analysis revealed a nonlinear, right-shifted U-shaped association between TFA and tear risk (P-nonlinearity < 0.001), with risk increasing at extreme rotational values, particularly increasing internal tibial rotation. ROC analysis showed modest improvements in discrimination with LPTS (area under the curve [AUC], 0.600 to 0.665; p = 0.041) and TFA tertiles (AUC, 0.600 to 0.674; p = 0.040); however, overall discrimination remained limited and these findings should be interpreted cautiously without external validation. CONCLUSION: Steeper lateral posterior tibial slope and greater tibiofemoral rotation were independent risk factors for LM tears in anterior cruciate ligament injuries. Tibiofemoral rotation showed a nonlinear increase in risk, driven mainly by excessive internal rotation. These parameters may provide additional context for preoperative risk stratification.