Correlation between onset of ACL injury and incidence of articular cartilage and meniscal injuries

Musaab Al-Samarrai, R. Khaffaf
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Abstract

Delayed anterior cruciate ligament (ACL) reconstruction surgery may increase the risk of chondral and meniscal injuries but the time interval between injury and surgery is not fully determined and the effect of ACL-deficiency rotational instability may vary among different zones of knee articular cartilage. Purpose To study chondral injuries in ACL-deficiency patients in different articular zones and various durations between ACL injury and reconstruction.: Case series – prospective observational study. Prospective observational study of 212 cases (197 male and 15 female) with specific age group (16-44 years) having ACL injury and managed by arthroscopic ACL reconstruction, articular cartilage injury rate and severity (based on ICRS classification) was assessed in 5 zones of knee articular cartilage and correlated with different durations between injury and surgery as well as correlation with concomitant meniscal injuries. Medial tibia was the most common zone of chondral injury in ACL-deficiency knee (54.2%) while patella was the least common zone (28.8%), severe chondral injuries rate increased from (3%) in patients who were operated within 6 months to (11.1%) in patients of 6-12 months group and higher with longer duration reaching to (63.6%) when ACLR was delayed more than 4 years from injury. Concomitant meniscal injuries were associated with higher rate of severe chondral injuries (20.4%) than cases without meniscal tear (4%), medial meniscal tears were more common (65%) than lateral tears (23.3%) while both menisci were observed in (11.7%), complex meniscal tear was the most common pattern (33.7%) on medial side. Delaying ACL reconstruction surgery will increase frequency of chondral injuries, severe chondral injuries rate is increased after 6 months in medial side and after 2 years on lateral side, concomitant meniscal injury is associated with higher rate of severe chondral lesions.
前交叉韧带损伤的发生与关节软骨和半月板损伤的关系
延迟前交叉韧带(ACL)重建手术可能会增加软骨和半月板损伤的风险,但损伤和手术之间的时间间隔并不完全确定,ACL缺乏性旋转不稳定的影响在膝关节软骨的不同区域可能有所不同。目的研究ACL缺失患者不同关节区软骨损伤及ACL损伤至重建的不同时间。病例系列-前瞻性观察性研究。前瞻性观察研究对特定年龄组(16-44岁)前交叉韧带损伤患者212例(男197例,女15例)进行关节镜下前交叉韧带重建,评估膝关节软骨5个区域的关节软骨损伤率和严重程度(基于ICRS分类),并与损伤与手术时间的不同以及与合并半月板损伤的相关性。在ACLR缺失的膝关节中,胫骨内侧是最常见的软骨损伤区(54.2%),髌骨是最不常见的软骨损伤区(28.8%),严重软骨损伤率从6个月内手术组的(3%)增加到6-12个月组的(11.1%),当ACLR延迟4年以上时,严重软骨损伤率更高,持续时间更长,达到(63.6%)。伴半月板损伤的严重软骨损伤发生率(20.4%)高于无半月板撕裂(4%),内侧半月板撕裂发生率(65%)高于外侧半月板撕裂发生率(23.3%),双半月板撕裂发生率(11.7%),内侧复杂半月板撕裂发生率最高(33.7%)。延迟前交叉韧带重建手术会增加软骨损伤的发生频率,内侧6个月后严重软骨损伤发生率增加,外侧2年后严重软骨损伤发生率增加,同时伴有半月板损伤,严重软骨病变发生率较高。
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