Background:

Biomechanical cadaveric studies have shown that Kaplan fibers (KFs) of the iliotibial band play a role in controlling anterolateral rotatory knee laxity in anterior cruciate ligament (ACL) injury. However, in the clinical setting, the contribution of injury to KFs on anterolateral rotatory laxity remains unclear.

Purpose:

To use magnetic resonance imaging (MRI) scans to detect concomitant KF injury in ACL-injured knees and to then examine the effect of KF injury on anterolateral rotatory laxity as measured by the pivot-shift test in a clinical setting.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

The study enrolled 91 patients with primary ACL tears (mean age 25 ± 11 years; 46 male and 45 female) whose MRI was conducted within 90 days after injury. KF injury was assessed by MRI according to previously reported criteria, and the patients were allocated to a KF injury group and a no–KF injury group. At the time of ACL reconstruction, the pivot-shift test was performed with the patient under anesthesia and quantitatively evaluated by tibial acceleration using an electromagnetic measurement system. Manual grading of the pivot-shift test was assessed according to guidelines of the International Knee Documentation Committee. The data were statistically compared between the 2 groups using Mann-Whitney U test and Fisher exact test (P < .05).

Results:

KFs were identified in 85 patients (93.4%), and KF injury was detected in 20 of the 85 patients (23.5%). No significant differences were observed between the KF injury group (n = 20) and the no–KF injury group (n = 65) in demographic characteristics, the period from injury to MRI (8.0 ± 14.0 days vs 8.9 ± 12.1 days, respectively), the rate of meniscal injury (50.0% vs 53.8%), or the rate of anterolateral ligament injury (45.0% vs 44.6%). Regarding the pivot-shift test, no significant differences were observed in tibial acceleration (1.2 m/s² [interquartile range, 0.5-2.1 m/s²] vs 1.0 m/s² [interquartile range, 0.6-1.7 m/s²], respectively) or manual grading between the 2 groups.

Conclusion:

Concomitant KF injury did not significantly affect the pivot-shift phenomenon in acute ACL-injured knees. The findings suggest that the contribution of KF injury to anterolateral rotatory knee laxity may be limited in the clinical setting.

中文翻译：

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髂胫束 Kaplan 纤维损伤对前交叉韧带损伤中膝关节前外侧旋转松弛的影响：一项回顾性队列研究

背景：

生物力学尸体研究表明，髂胫束的 Kaplan 纤维 (KFs) 在控制前交叉韧带 (ACL) 损伤中的前外侧旋转膝关节松弛方面发挥作用。然而，在临床环境中，KFs 损伤对前外侧旋转松弛的影响仍不清楚。

目的：

使用磁共振成像 (MRI) 扫描来检测 ACL 损伤膝关节中伴随的 KF 损伤，然后检查 KF 损伤对前外侧旋转松弛的影响，在临床环境中通过枢轴移位测试测量。

学习规划：

横断面研究；证据水平，3。

方法：

该研究招募了 91 名原发性 ACL 撕裂患者（平均年龄 25 ± 11 岁；46 名男性和 45 名女性），他们在受伤后 90 天内进行了 MRI 检查。根据先前报道的标准通过 MRI 评估 KF 损伤，并将患者分配到 KF 损伤组和无 KF 损伤组。在 ACL 重建时，在患者麻醉下进行枢轴移位测试，并使用电磁测量系统通过胫骨加速度进行定量评估。根据国际膝关节文献委员会的指南评估了枢轴移位测试的手动分级。两组数据采用Mann-Whitney U检验和Fisher精确检验进行统计学比较（P < .05）。

结果：

85 名患者 (93.4%) 发现了 KF，85 名患者中有 20 名 (23.5%) 发现了 KF 损伤。KF 损伤组（n = 20）和非 KF 损伤组（n = 65）在人口统计学特征、从损伤到 MRI 的时间（分别为 8.0 ± 14.0 天和 8.9 ± 12.1 天）方面没有观察到显着差异，半月板损伤率（50.0% vs 53.8%），或前外侧韧带损伤率（45.0% vs 44.6%）。关于枢轴移位测试，胫骨加速度没有显着差异（1.2 m/s ² [四分位距，0.5-2.1 m/s ² ] vs 1.0 m/s ² [四分位距，0.6-1.7 m/s ² ]，分别）或在 2 组之间手动评分。

结论：

伴随的 KF 损伤并没有显着影响急性 ACL 损伤膝关节的枢轴移位现象。研究结果表明，KF 损伤对前外侧旋转膝关节松弛的贡献可能在临床环境中受到限制。