전방십자인대 파열에 있어 대퇴과간 절흔 폭과 후방 경골 경사각의 임상적 의의
Clinical Relevance of the Femoral Intercondylar Notch Width and the Posterior Tibial Slope for ACL Rupture
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목적: 대퇴과간 절흔 폭과 후방 경골 경사각이 전방십자인대 파열 및 파열 위치에 미치는 영향에 대하여 알아보고자 하였다. 대상 및 방법: 2002년 2월부터 2009년 7월 사이에 본원에서 전방십자인대 파열로 치료받은 환자 105예 (105명) 및 대조군으로 전방십자인대 비파열군 91예(91명)에 대하여 단순 방사선 사진을 이용하여 대퇴과간 절흔 폭과 후방 경골 경사각을 측정하였다. 또한 전방십자 인대의 파열 위치에 따라서 대퇴골 부착부위, 중간부위, 경골부착부위 파열군으로 분류하여 각 군에서의 상관관계를 분석하였다. 결과: 대퇴과간 절흔 폭의 평균은 전방십자인대 파열군 15.51±4.30 mm (95% confidence interval: 15.48∼15.53), 비파열군 24.49±3.86 mm (24.47∼24.52)이었으며, 후방 경골 경사각은 파열군 평균 7.68±3.78o (7.65∼7.70), 비파열군 6.12±3.85o (6.10∼6.13)이며, 대퇴과간 절흔 폭과 전방십자인대 파열 사이에는 연관성이 있었다(교차비=0.661 [0.602∼0.720], p＜0.01). 후방 경골 경사각과는 연관성이 없었다(교차비=1.073 [1.062∼1.134], p=0.197). 파열 위치에 따른 분산분석에서는 통계학적으로 의미있는 결과를 관찰할 수는 없었다. 결론: 전방십자인대 파열에 있어서 대퇴과간 절흔 폭의 감소는 의미있는 위험 요소임을 알 수 있었다.
Abstract
Purpose: The purpose of this study was to evaluate the relationship between the femoral intercondylar notch width (ICW), the posterior tibial slope angle (PTS), rupture of the anterior cruciate ligament (ACL) and the ruptured site. Materials and Methods: We retrospectively reviewed 105 cases of ruptured ACL (105 patients), and 91 cases of intact ACL (91 patients). The ICW and PTS were measured from the plain knee radiographs. The ratio of the ICW and the femoral intercondylar notch height (ICH) was also measured. As for the site of ACL rupture, the patients with a ruptured ACL were divided into 3 groups (group 1: femoral attach site, 2: mid-substance, 3: tibial attach site), and the correlations between the ICW and the PTS of each group were analyzed. Results: The mean ICW of the ACL ruptured group was 15.51±4.30 mm (95% confidence interval: 15.48∼15.53), that of the ACL intact group was 24.49±3.86 mm (24.47∼24.52), and the mean PTS of the ruptured ACL group was 7.68±3.78o (7.65∼7.70) and that of the intact ACL group was 6.12±3.85o (6.10∼6.13). A narrow ICW was a significant risk factors for ACL rupture (odds ratio=0.661 [0.602∼0.720], p＜0.01). But we did not get any statistically significant results for the increase PTS (odds ratio=1.073 [1.062∼1.134], p=0.197). According to the ruptured site, the analysis of variance of the ICW and PTS had no significant correlation. Conclusion: A narrow ICW is a significant risk factor for ACL rupture.
참고문헌 (27)
- Agneskirchner JD, "Effect of high tibial flexion osteotomy on cartilage pressure and joint kinematics: a biomechanical study in human cadaveric knees. Winner of the AGA-DonJoy Award 2004", Arch Orthop Trauma Surg, 124, pp.575~584 (2004)
- Ahn JH, "Arthroscopic surgery for the acute anterior cruciate ligament injury", J Korean Orthop Assoc, 30, pp.291~297 (1995)
- Allen MK, "Metrecom measurement of navicular drop in subjects with anterior cruciate ligament injury", J Athl Train, 35, pp.403~406 (2000)
- 배대경, "후방십자인대 보존형 슬관절 전치환술 전후의 후방 경사각 변화", 대한정형외과학회지, 43(2), pp.207~212 (2008), 대한정형외과학회
- Beynnon BD, "Treatment of anterior cruciate ligament injuries, part I", Am J Sports Med, 33, pp.1579~1602 (2005)
- Davis TJ, "Correlation of the intercondylar notch width of the femur to the width of the anterior and posterior cruciate ligaments", Knee Surg Sports Traumatol Arthrosc, 7, pp.209~214 (1999)
- Dejour H, "Tibial translation after anterior cruciate ligament rupture. Two radiological tests compared", J Bone Joint Surg Br, 76, pp.745~749 (1994)
- Dienst M, "Correlation of intercondylar notch cross sections to the ACL size: a high resolution MR tomographic in vivo analysis", Arch Orthop Trauma Surg, 127, pp.253~260 (2007)
- Feagin JA Jr, "Mechanism of injury and pathology of anterior cruciate ligament injuries", Orthop Clin North Am, 16, pp.41~45 (1985)
- Good L, "Intercondylar notch measurements with special reference to anterior cruciate ligament surgery", Clin Orthop Relat Res, (263), pp.185~189 (1991)
- Griffin LY, "Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005", Am J Sports Med, 34, pp.1512~1532 (2006)
- Hewett TE, "Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study", Am J Sports Med, 33, pp.492~501 (2005)
- Hewett TE, "Effects of the menstrual cycle on anterior cruciate ligament injury risk: a systematic review", Am J Sports Med, 35, pp.659~668 (2007)
- Ireland ML, "A radiographic analysis of the relationship between the size and shape of the intercondylar notch and anterior cruciate ligament injury", Knee Surg Sports Traumatol Arthrosc, 9, pp.200~205 (2001)
- LaPrade RF, "Femoral intercondylar notch stenosis and correlation to anterior cruciate ligament injuries. A prospective study", Am J Sports Med, 22, pp.198~202 (1994)
- Lund-Hanssen H, "Intercondylar notch width and the risk for anterior cruciate ligament rupture. A case-control study in 46 female handball players", Acta Orthop Scand, 65, pp.529~532 (1994)
- Myer GD, "The effects of generalized joint laxity on risk of anterior cruciate ligament injury in young female athletes", Am J Sports Med, 36, pp.1073~1080 (2008)
- Norwood LA Jr, "The intercondylar shelf and the anterior cruciate ligament", Am J Sports Med, 5, pp.171~176 (1977)
- Rosenberg TD, "The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee", J Bone Joint Surg Am, 70, pp.1479~1483 (1988)
- Shelbourne KD, "The relationship between intercondylar notch width of the femur and the incidence of anterior cruciate ligament tears. A prospective study", Am J Sports Med, 26, pp.402~408 (1998)
- Shelbourne KD, "Radiographic and intraoperative intercondylar notch width measurements in men and women with unilateral and bilateral anterior cruciate ligament tears", Knee Surg Sports Traumatol Arthrosc, 5, pp.229~233 (1997)
- Shoemaker SC, "The role of the meniscus in the anterior-posterior stability of the loaded anterior cruciate-deficient knee. Effects of partial versus total excision", J Bone Joint Surg Am, 68, pp.71~79 (1986)
- Souryal TO, "Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study", Am J Sports Med, 21, pp.535~539 (1993)
- Teitz CC, "Symmetry of the femoral notch width index", Am J Sports Med, 25, pp.687~690 (1997)
- Todd MS, "The relationship between posterior tibial slope and anterior cruciate ligament injuries", Am J Sports Med, 38, pp.63~67 (2010)
- Uhorchak JM, "Risk factors associated with noncontact injury of the anterior cruciate ligament: a prospective four-year evaluation of 859 West Point cadets", Am J Sports Med, 31, pp.831~842 (2003)
- Woodford-Rogers B, "Risk factors for anterior cruciate ligament injury in high school and college athletes", J Athl Train, 29, pp.343~346 (1994)