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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >A Cam Shaped Femur Might Be A Risk Factor for ACL Injuries
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A Cam Shaped Femur Might Be A Risk Factor for ACL Injuries

机译：凸轮形股骨可能是ACL损伤的危险因素

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Objectives: Bony morphologic characteristics have been demonstrated to increase the risk of anterior cruciate ligament (ACL) injury. While posterior femoral condyle condylar offset is an aspect of distal femoral bony morphology that has been reported to influence range of motion and other aspects of knee joint kinematics, it remains unclear whether this characteristic influences the risk of ACL injury. The purpose of the study was to examine the relationship between distal femoral morphology and risks of ACL injury, reconstruction failure, and contralateral ACL injury. It was hypothesized that increased posterior femoral condylar depth, quantified as the cam ratio, would correlate with increased risk of primary ACL injuries, ACL reconstruction failures, and contralateral ACL injuries. Methods: Consecutive patients undergoing evaluation for knee complaints at an academic medical center from 2012-2016 with minimum 24-month follow-up were retrospectively reviewed. Subjects were stratified into four groups: a control group consisting of patients with no ACL injuries and three groups of patients with a primary ACL injury, failed ACL reconstruction, or previous ACL injury with subsequent contralateral ACL injury. Using lateral radiographs, the ratio of posterior condylar depth over total condylar distance was defined as the cam ratio. Analysis-of-variance (ANOVA) and post-hoc testing were used to test for differences in the mean tomahawk ratio between study groups (p<0.05). Receiver Operating Characteristic (ROC) analysis was performed to determine the optimal cam ratio cut-off for detecting increased risk for ACL injury. Results: One hundred and seventy-five patients met inclusion criteria. The mean cam ratios in the control, primary ACL injury, failed ACL reconstruction, and contralateral ACL injury groups were 61.1% (± 2.1), 64.2% (± 3.8), 64.4% (± 3.6), and 66.9% (± 4.0), respectively. Patients with a primary ACL injury, failed ACL reconstruction, or contralateral ACL injury had a significantly higher cam ratio compared to the control group (p<0.008). ROC analysis demonstrated a cam ratio of 63% or greater to be associated with an increased risk for ACL injury with a sensitivity of83% and a specificity of 71%. Conclusion: The data from this study show that an increased posterior femoral condylar depth, or cam ratio, might be associated with increased risk of ACL injury, including primary ACL injury, failed ACL reconstruction, and contralateral ACL injury. The data from this study may help clinicians identify patients at greater risk of ACL injury and re-injury. Future prospective studies will be helpful in investigating the mechanism by which an increased cam ratio increases ACL injury risk and potential strategies to mitigate the increased risk posed by this bony characteristic.
机译：目的：已证实骨的形态特征会增加前十字韧带（ACL）损伤的风险。虽然股后con突偏移是股骨远端骨形态的一个方面，据报道会影响运动范围和膝关节运动学的其他方面，但尚不清楚该特征是否影响ACL损伤的风险。该研究的目的是检查股骨远端形态与ACL损伤，重建失败和对侧ACL损伤风险之间的关系。假设增加的股后con深度（以凸轮比表示）将与原发性ACL损伤，ACL重建失败和对侧ACL损伤的风险增加相关。方法：回顾性分析2012-2016年在学术医疗中心接受膝关节不适评估的连续患者，并至少随访24个月。将受试者分为四组：对照组，由无ACL损伤的患者组成;三组由原发性ACL损伤，ACL重建失败或先前的ACL损伤及随后的对侧ACL损伤组成。使用侧位X线照片，将con后深度与over总距离之比定义为凸轮比。方差分析（ANOVA）和事后检验用于检验研究组之间的平均战斧比差异（p <0.05）。进行接收器工作特征（ROC）分析以确定最佳的凸轮比截止值，以检测出增加的ACL损伤风险。结果：175例患者符合入选标准。对照组，原发性ACL损伤，ACL重建失败和对侧ACL损伤组的平均凸轮比率分别为61.1％（±2.1），64.2％（±3.8），64.4％（±3.6）和66.9％（±4.0） ， 分别。与对照组相比，原发性ACL损伤，ACL重建失败或对侧ACL损伤的患者的凸轮比率显着更高（p <0.008）。 ROC分析表明，凸轮比率为63％或更高与ACL损伤风险增加相关，灵敏度为83％，特异性为71％。结论：这项研究的数据表明，股骨后con深度或凸轮比增加可能与ACL损伤的风险增加有关，包括原发性ACL损伤，ACL重建失败和对侧ACL损伤。这项研究的数据可能有助于临床医生识别出发生ACL损伤和再伤风险更高的患者。未来的前瞻性研究将有助于调查增加凸轮比率增加ACL损伤风险的机制，以及减轻这种骨质特征引起的风险增加的潜在策略。

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