• 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Is Medial Tibial Slope Associated With Non-contact ACL Tears? An Analysis Of Primary And Revision Acl Reconstruction Patients
【24h】

Is Medial Tibial Slope Associated With Non-contact ACL Tears? An Analysis Of Primary And Revision Acl Reconstruction Patients

机译：胫骨内侧倾斜是否与非接触式ACL撕裂相关？原发和修订Acl重建患者的分析

获取原文
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

Objectives: Increased tibial slope (TS) may be associated with non-contact ACL injuries although potential confounding effects from various patient characteristics and radiographic quantification methods have not been rigorously studied. The association of TS with recurrent non-contact ACL injury after primary reconstruction is less defined. The purpose of this study was: 1) to assess the reliability and variability of TS values among different examiners, and 2) to compare TS between patients undergoing primary ACL reconstruction, re-injured patients undergoing revision ACL reconstruction, and an ACL-intact cohort. Methods: A total of 206 patients were prospectively enrolled in this single center, IRB-approved study that consisted of 3 groups: 1) ACL intact controls (CTRL, n=83), 2) first-time ACL injured patients from a non-contact mechanism (PRIM, n=77), and 3) patients with repeated non-contact ACL injury after primary ACL reconstruction (REV, n=46). Patients with prior knee surgery, radiographic signs of arthritis, chondral lesions ≥ grade 2, or insufficient radiographs were excluded. Repeated measurements of anterior and posterior TS were performed by 3 fellowship-trained sports medicine surgeons based on the previously described Utzschneider method that has a strong correlation to CT and MRI measurements. The anterior tibial slope (ATS) and posterior tibial slope (PTS) were measured to calculate an approximate mean medial tibial slope (MTS) based on the anatomic tibial axis. ( Fig. 1 ). The intra- and inter-observer reliability were assessed by intra-class correlation coefficients (ICC). The MTS, ATS, PTS, age, BMI and sex distribution were compared among the three groups using one-way ANOVA with Tukey’s post hoc test and Chi-square test, respectively. The independent association of TS with ACL-intact controls (CTRL) vs. positive ACL injury (PRIM + REV) was assessed by multivariable logistic regression for MTS, ATS, and PTS, respectively. An a priori power analysis determined that 45 patients per group were needed to achieve a statistical power > 80% to detect a 1° difference (SD=3°) with α=0.05. Results: The ICC for intra- and inter-observer reliability in the calculation of TS ranged from 0.73-0.89 indicating substantial agreement. There was no significant difference in values for MTS, ATS, and PTS between the CTRL, PRIM and REV groups (p=0.42, 0.12, and 0.42, respectively). Patient age was highest in the CTRL group, followed by the REV, then PRIM groups (p<0.001) ( Table 1 ). None of the TS values were independently associated with ACL injury based on multivariable logistic regression adjusted for age and sex. The mean ATS for all 206 subjects was 5° and 10° greater than that of the MTS and PTS, respectively (p < 0.001). ATS correlated only moderately to PTS (R~(2)=0.49, p < 0.001). Conclusion: There is substantial intra- and inter-observer reliability in the radiographic assessment of medial tibial slope. Medial tibial slope was not associated with first time non-contact ACL tears or recurrent ACL graft tears undergoing reconstruction. Table 1. Patient characteristics and tibial slope quantified for three study groups. CTRL (n=83) PRIM (n=77 REV (n-46) p value Age (y.o) 37.1 +/-12.3 18.9 +/- 4.6 25.0 +/- 8.2 Sex (female, %) 56.6% 53.3% 39.1% 0.15 BMI (kg/m~(2)) 26.6 +/- 5.9 24.7 +/- 4.5 26.5 +/- 4.4 0.83 ATS (degrees) 14.7 +/- 3.4 13.8 +/- 2.8 13.8 +/- 3.0 0.12 MTS (degrees) 10.2 +/- 3.1 9.6 +/- 2.7 10.0 +/- 2.7 0.42 PTS (degrees) 5.6 +/- 3.3 5.4 +/- 3.0 6.1 +/- 2.9 0.12.
机译：目的：胫骨斜率（TS）的增加可能与非接触性ACL损伤有关，尽管尚未对来自各种患者特征和X线照相定量方法的潜在混杂效应进行严格研究。初次重建后TS与复发性非接触性ACL损伤的相关性尚不清楚。这项研究的目的是：1）评估不同检查者之间TS值的可靠性和变异性，以及2）比较接受原发性ACL重建的患者，经过再造ACL重建的再受伤患者以及ACL完整队列的TS 。方法：总共206名患者前瞻性地参加了IRB批准的单中心研究，该研究包括3组：1）ACL完整对照（CTRL，n = 83），2）非ACL的首次ACL损伤患者接触机制（PRIM，n = 77），以及3）原发性ACL重建后反复非接触性ACL损伤的患者（REV，n = 46）。先前接受过膝关节手术，关节炎的影像学体征，≥2级的软骨损伤或X线照片不足的患者被排除在外。 3名受过研究金培训的运动医学外科医生根据先前描述的Utzschneider方法（与CT和MRI测量具有很强的相关性）对前TS和后TS进行了重复测量。测量胫骨前斜率（ATS）和胫骨后斜率（PTS），以根据解剖胫骨轴计算近似平均胫骨内侧斜率（MTS）。 （ 图。1 ）。观察者内部和观察者之间的可靠性通过类内相关系数（ICC）进行评估。使用单向方差分析，Tukey事后检验和卡方检验，分别比较了三组的MTS，ATS，PTS，年龄，BMI和性别分布。通过MTS，ATS和PTS的多变量logistic回归评估了TS与ACL完整对照（CTRL）与阳性ACL损伤（PRIM + REV）的独立关联。先验功效分析确定每组需要45名患者才能达到统计功效> 80％，以检测1°差异（SD = 3°）且α= 0.05。结果：在TS的计算中，观察者内和观察者间ICC的ICC为0.73-0.89，这表明存在很大的一致性。 CTRL，PRIM和REV组之间的MTS，ATS和PTS值没有显着差异（分别为p = 0.42、0.12和0.42）。 CTRL组的患者年龄最高，其次是REV，然后是PRIM组（p <0.001）（表1）。根据针对年龄和性别调整的多变量逻辑回归，没有一个TS值与ACL损伤独立相关。所有206名受试者的平均ATS分别比MTS和PTS高5°和10°（p <0.001）。 ATS与PTS的相关性中等（R〜（2）= 0.49，p <0.001）。结论：在胫骨内侧倾斜的影像学评估中，观察者间和观察者间的可靠性很高。胫骨内侧倾斜与第一次非接触性ACL撕裂或复发性ACL移植物撕裂进行重建无关。表1.对三个研究组进行量化的患者特征和胫骨斜率。 CTRL（n = 83）PRIM（n = 77 REV（n-46）p值年龄（yo）37.1 +/- 12.3 18.9 +/- 4.6 25.0 +/- 8.2性别（女，％）56.6％53.3％39.1％ 0.15 BMI（kg / m〜（2））26.6 +/- 5.9 24.7 +/- 4.5 26.5 +/- 4.4 0.83 ATS（度）14.7 +/- 3.4 13.8 +/- 2.8 13.8 +/- 3.0 0.12 MTS（度）10.2 +/- 3.1 9.6 +/- 2.7 10.0 +/- 2.7 0.42 PTS（度）5.6 +/- 3.3 5.4 +/- 3.0 6.1 +/- 2.9 0.12。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号