胫骨后交叉韧带撕脱伤的改良分类及其与半月板和韧带损伤的关系。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2025-07-03 DOI:10.1016/j.jisako.2025.100921

Amit Joshi, Alok Thaiba, Hiramani Paudyal, Umair Ahmad

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引用次数: 0

摘要

简介：虽然Myer和McKeever的系统是最常用的分类胫骨后交叉韧带撕脱伤（TAPCL）损伤，但一些出版物报道的损伤不能根据该系统进行分类。因此，有必要修改这种分类。TAPCL的治疗取决于碎片的移位和相关的半月板和韧带损伤。本研究的主要目的是提出一种改进的分类，并评估半月板和韧带损伤与不同类型TAPCL的关系。方法：对2019年8月至2024年8月期间在本中心就诊的患者进行回顾性分析研究。记录人口学参数后，根据修改后的分类将所有病例分为5种不同的类型。记录半月板和韧带损伤的发生率。采用SPSS软件进行统计分析。采用Shapiro-Wilk检验对数据的正态性进行检验。基于正态分布，数据以平均值+/-标准差或中位数（四分位间距）表示。分类数据以数字（百分比）表示。比较分析采用Pearson卡方检验，采用2x3和2x2列联表；对2x2表计算比值比和95%置信区间。结果：以ⅲ型损伤最多（39.68%），其次为ⅱ型（23.58%）、ⅳ型（17.92%）、V型（12.27%）。32例（30.19%）为未纳入Myer和McKeever分类系统的IV型和V型。半月板损伤的总发生率为24.53%，伴有韧带损伤的患者占27.36%。更重要的是，89.66%的韧带损伤和所有半月板损伤与高度撕脱类型相关（p < 0.05）。其中，半月板损伤发生率为73.07%，韧带损伤发生率为51.72%。结论：我们的队列中有三分之一的后交叉韧带胫骨撕脱骨折不能用Myer和McKeever分类系统进行分类，其中32例（30.19%）为IV型和v型，近三分之一的TAPCL发现有半月板或其他韧带损伤。韧带和半月板损伤的发生率较高，亚型级别较高。证据级别：IV。

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A modified classification of tibial avulsion of the posterior cruciate ligament and its association with meniscal and ligament injuries

Introduction

Although Myer and McKeever's system is most commonly used to classify tibial avulsion of the posterior cruciate ligament (TAPCL) injuries, some publications report injuries that cannot be classified according to this system. Hence, there was a need to modify this classification. Management of TAPCL depends on the displacement of the fragment and associated meniscal and ligament injuries. The primary aim of this study was to propose a modified classification and assess the association of meniscus and ligament injuries with various types of TAPCLs.

Methods

This was a retrospective, analytical study of patients managed at our center between August 2019 and August 2024. After recording the demographic parameters, all the cases included were classified into five different types according to the modified classification. The incidence of meniscus and ligament injuries was recorded. Statistical analysis was performed using SPSS software. The normality of the data was tested using the Shapiro-Wilk test. Based on the normal distribution, data were expressed as mean ± standard deviation or median (interquartile range). Categorical data were expressed as numbers (percentages). Comparative analysis used Pearson chi-squared tests with 2×3 and 2×2 contingency tables; odds ratios and 95% confidence intervals were calculated for 2×2 tables.

Results

Type III injuries were the most common ones (39.68%), followed by type II (23.58 %), type IV (17.92 %), and type V injuries (12.27 %). Thirty-two cases (30.19%) were categorized as types IV and V, which are not accounted for in the Myer and McKeever classification system. The overall incidence of meniscal injury was 24.53%, and 27.36% of patients exhibited associated ligamentous injuries. More importantly, 89.66% of ligament injuries and all meniscal injuries occurred in association with high-grade avulsion types (P > 0.05). Specifically, 73.07% of meniscal injuries and 51.72% of ligamentous injuries were observed in type IV and V cases.

Conclusion

One-third of posterior cruciate ligament tibial avulsion fractures in our cohort could not be classified using the Myer and McKeever classification system as 32 (30.19%) were categorized as type IV and V. Nearly one-third of the TAPCLs were found to have meniscus or other ligament injuries. A higher incidence of ligament and meniscal injuries was noted with higher-grade subtypes.