关节镜下外侧胫骨平台位移与前交叉韧带损伤膝关节轴移严重程度相关
简介
这项回顾性比较研究（Level III）纳入60例经临床、MRI和关节镜证实的孤立ACL断裂患者（18–45岁），在屈膝30°外翻及内旋应力下，通过标准化高清关节镜视频和校准探针测量外侧胫骨平台平移，并由2名观察者独立重复。平均平移为4.6±1.7 mm（范围2–8 mm），观察者内、间ICC分别为0.91和0.89；平移与术前轴移分级强相关（r=0.72，…
英文摘要
PURPOSE: To quantify arthroscopic lateral tibial plateau (LTP) translation in anterior cruciate ligament (ACL)-deficient knees using a standardized intraoperative protocol and to evaluate its association with pivot-shift grade and lateral tibial slope, including its ability to discriminate high-grade pivot-shift. METHODS: Patients aged 18 to 45 years with an isolated ACL rupture confirmed by clinical examination, magnetic resonance imaging, and arthroscopy who met the predefined eligibility criteria and had arthroscopic video of adequate quality for measurement underwent standardized arthroscopic assessment of LTP translation. Arthroscopic LTP translation was quantified from standardized high-definition arthroscopic video recordings using a calibrated probe during valgus and internal rotation stress at 30° of knee flexion. Measurements were independently repeated by 2 observers. Associations with preoperative pivot-shift grade and lateral tibial slope were assessed. Diagnostic performance was evaluated using receiver operating characteristic analysis. RESULTS: Sixty patients (38 men, 22 women; mean age 29.8 ± 6.7 years) were included in the final analysis. Mean arthroscopic LTP translation was 4.6 ± 1.7 mm (range, 2-8 mm). Reproducibility was excellent (intraclass correlation coefficient intra = 0.91; inter = 0.89). LTP translation strongly correlated with pivot-shift grade (r = 0.72, P < .001) and moderately with lateral tibial slope (r = 0.51, P = .003). Receiver operating characteristic analysis showed an area under the curve of 0.85 (95% confidence interval, 0.77-0.93). A threshold of >5 mm yielded 82% sensitivity and 78% specificity for detecting high-grade pivot-shift. CONCLUSIONS: Arthroscopic quantification of LTP translation is a reproducible and clinically relevant method for objectively assessing rotational instability in ACL-deficient knees. Arthroscopic quantification of LTP translation showed excellent inter- and intraobserver reliability and was strongly associated with preoperative pivot-shift grade. A translation threshold greater than 5 mm showed good discriminative performance for identifying high-grade pivot-shift. LEVEL OF EVIDENCE: Level III, retrospective comparative study.