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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Is Edema at the Posterior Medial Tibial Plateau Indicative of Ramp Lesion? An Examination of 852 Patients with Anterior Cruciate Ligament Reconstruction
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Is Edema at the Posterior Medial Tibial Plateau Indicative of Ramp Lesion? An Examination of 852 Patients with Anterior Cruciate Ligament Reconstruction

机译：胫骨后内侧高原水肿是否提示斜坡病变？ 852例前交叉韧带重建患者的检查

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Objectives: Meniscal injuries are commonly observed with anterior cruciate ligament (ACL) deficiency. A subset of these injuries includes tears of the medial meniscus at the posterior meniscocapsular junction, or ramp lesions. Biomechanical studies have indicated that ramp injuries may compromise anterior stability of the knee, even after ACL reconstruction (ACLR). These lesions are not consistently diagnosed with magnetic resonance imaging (MRI). One criterion that shows promise is the presence of posterior medial tibial plateau (PMTP) edema. A correlation of PMTP edema and peripheral posterior horn medial meniscal injuries has been observed in the literature. We evaluated a consecutive series of patients who underwent ACLR for incidence of ramp tears. These patients were then compared to patients with non-ramp (meniscal body) medial meniscal tears. The utility of PMTP edema on preoperative MRI for ramp tear diagnosis was then determined. Methods: A retrospective chart review via an institutional database search identified 892 patients who underwent ACLR by one of two senior authors (R.A.A., C.E.) between January 2006 and June 2016. Operative notes identified patients diagnosed arthroscopically with medial meniscal lesions, including ramp lesions. Arthroscopic identification was the gold standard for diagnosis of both ramp and non-ramp (meniscal body) tears. Demographic information such as age, sex, laterality, mechanism of injury (contactoncontact), sport, revision procedure, multi-ligament procedure, time to MRI, and time to surgery were recorded. Patients without available operative records were excluded. Preoperative MRIs were obtained for all patients and reviewed by an orthopaedic sports medicine fellow for PMTP edema. Axial, coronal, and sagittal T2 and proton-density sequences were utilized. A MRI was considered positive if edema was detected in 2 different planes of sequences. Differences between groups were analyzed with two-sample t test or Chi square test Univariate and multivariate logistic regression models analyzed the relationships among patient factors, MRI findings, and ramp lesions. Results: 852 patients met the inclusion criteria for analysis. 307 patients were diagnosed with medial meniscal tear at the time of ACLR, 127 of which were ramp lesions. The overall incidence of ramp tear was 14.9% and consisted of 41.4% of all medial meniscal tears. Patients with ramp tears were mean 7.5 years younger than patients with meniscal body tears ( p <0.01). There was no difference between the groups in regard to mechanism of injury, revision surgery, or multi-ligamentous injury. Patients with delayed ACLR were at 3.3x greater odds ( p <0.01) of having meniscal body tear compared to ramp lesion. MRI was available for review in 178 patients, 97 of whom had positive MRI for PMTP edema. Sensitivity and specificity of PMTP edema for ramp tear was 66.3% and 55.1%, respectively. Of patients with PMTP edema, 54.6% had ramp lesions and 45.4% had non-ramp tears ( p <0.01). Patients with preoperative MRI positive for PMTP edema were at 2.1 times greater odds ( p <0.01) of having sustained a ramp tear compared to a meniscal body tear. Conclusion: The incidence of ramp tear was 14.9% and was more prevalent in younger patients. Delayed ACLR resulted in 3.3x greater odds of meniscal body tears compared to ramp tears. Patients with PMTP edema on preoperative MRI were at 2.1x greater odds to have ramp lesions compared to a meniscal body tears at the time of ACL reconstruction.
机译：目的：半月板损伤通常观察到前交叉韧带（ACL）缺乏。这些损伤的一部分包括后半囊膜交界处的内侧半月板的撕裂或斜坡损伤。生物力学研究表明，即使在ACL重建（ACLR）后，坡道损伤也可能损害膝关节的前稳定性。这些病变不能用磁共振成像（MRI）一致地诊断。表现出希望的一项标准是胫骨后内侧平台（PMTP）水肿的存在。文献中已观察到PMTP水肿与周围后角内侧半月板损伤的相关性。我们评估了接受ACLR治疗的一系列连续患者斜道撕裂的发生率。然后将这些患者与非斜坡（半月板）内侧半月板撕裂的患者进行比较。然后确定了PMTP水肿在术前MRI上诊断斜坡撕裂的效用。方法：通过机构数据库搜索进行的回顾性图表审查，确定了两名资深作者（R.A.A.，C.E.）在2006年1月至2016年6月之间对892例ACLR进行了手术的患者。手术记录确定了经关节镜检查诊断为内侧半月板病变（包括斜坡病变）的患者。关节镜鉴定是诊断斜面和非斜面（半月板）眼泪的金标准。记录人口统计信息，例如年龄，性别，偏侧性，损伤机制（接触/非接触），运动，翻修程序，多次结扎程序，MRI时间和手术时间。没有可用手术记录的患者被排除在外。对所有患者进行术前MRI检查，并由骨科运动医学专家对PMTP水肿进行检查。利用轴向，冠状和矢状T2和质子密度序列。如果在2个不同的序列平面中检测到水肿，则MRI视为阳性。使用二样本t检验或卡方检验分析两组之间的差异。单因素和多因素Logistic回归模型分析了患者因素，MRI表现和坡道病变之间的关系。结果：852名患者符合纳入标准进行分析。 307名患者在ACLR时被诊断患有半月板内侧撕裂，其中127例是斜道病变。斜道撕裂的总发生率为14.9％，占所有内侧半月板撕裂的41.4％。坡道眼泪患者平均比半月板眼泪患者年轻7.5岁（p <0.01）。两组之间在损伤机制，翻修手术或多韧带损伤方面没有差异。与斜坡病变相比，延迟ACLR患者半月板​​撕裂的几率高3.3倍（p <0.01）。 178例患者可进行MRI检查，其中97例PMTP水肿MRI阳性。 PMTP水肿对斜道撕裂的敏感性和特异性分别为66.3％和55.1％。在PMTP水肿患者中，有54.6％的患者有斜道病变，有45.4％的患者无斜道眼泪（p <0.01）。术前MRI呈PMTP水肿阳性的患者，与半月板体撕裂相比，发生斜坡撕裂的几率（p <0.01）高2.1倍。结论：斜坡撕裂的发生率为14.9％，在年轻患者中更为普遍。延迟ACLR导致半月板体泪的几率是斜面泪的3.3倍。与ACL重建时的半月板眼泪相比，术前MRI上PMTP水肿的患者发生斜道病变的几率高2.1倍。

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