A small notch width index, steeper medial and lateral tibial slope and higher lateral/medial tibial slope ratio are relevant knee morphological factors for ACL injuries in skeletally immature patients—A systematic review

IF 2.7 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2025-03-22 DOI:10.1002/jeo2.70211

Robin Voskuilen, Martijn Dietvorst, Marieke van der Steen, Rob P. A. Janssen

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Abstract

Purpose

The incidence of anterior cruciate ligament (ACL) injuries in skeletally immature patients has drastically increased over the last decades. Morphology of the knee might play an important role. This literature review provides a systematic overview of knee morphological factors relevant to ACL injury in skeletally immature patients. The hypothesis of the present study is that multiple knee morphological parameters—such as a steep medial and lateral tibial slope (MTS and LTS) and a narrow intercondylar notch—can be identified as potentially relevant factors for ACL injury in this population.

Methods

Systematic review according to PRISMA guidelines. MEDLINE, Embase and Cochrane were searched in December 2023 for studies reporting on knee morphology and ACL injury in skeletally immatures. The following inclusion criteria were used: English/Dutch studies, full-text available, human studies and skeletally immature patients. Parameters with clinical homogeneity and presented in two or more studies as means with standard deviation were included in a meta-analysis using RevMan. Parameters that could not be included in the meta-analyses were presented in a descriptive manner.

Results

After screening 1825 studies, a total of 18 studies were included, of which 16 studies had parameters included in the meta-analyses. These studies investigated 31 knee morphological factors for ACL injury in skeletally immatures. Meta-analyses identified a smaller notch width index (NWI) (0.25 vs. 0.26, mean difference: −0.02 95% confidence interval [CI]: −0.03 to −0.01, p ≤ 0.00001) steeper MTS and LTS (4.8° vs. 3.6° (mean difference: 0.55° 95% CI: 0.09–1.01, p = 0.02) and 4.3° vs 2.8° (mean difference: 2.04° 95% CI: 0.75–3.32, p = 0.0003), respectively) and higher LTS/MTS ratio as risk factors for ACL injury in skeletally immature patients.

Conclusions

A small NWI, steeper MTS and LTS and higher LTS/MTS ratios were identified as relevant knee morphological factors for ACL injuries in skeletally immature patients.

Level of Evidence

Level III.

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切口宽度指数较小、胫骨内外侧坡度较陡、胫骨外侧/内侧坡度比较大是骨骼尚未发育成熟的患者前交叉韧带损伤的相关膝关节形态因素--系统综述

在过去的几十年里，前交叉韧带（ACL）损伤在骨骼未成熟患者中的发生率急剧增加。膝关节形态可能起重要作用。这篇文献综述提供了一个系统的概述膝关节形态学因素相关的前交叉韧带损伤在骨骼不成熟的患者。本研究的假设是，多种膝关节形态参数-如陡峭的胫骨内侧和外侧斜坡（MTS和LTS）和狭窄的髁间缺口-可以确定为该人群中ACL损伤的潜在相关因素。方法按照PRISMA指南进行系统评价。MEDLINE， Embase和Cochrane于2023年12月检索了关于骨骼不成熟患者膝关节形态和前交叉韧带损伤的研究报告。采用以下纳入标准：英语/荷兰语研究，可获得全文，人类研究和骨骼未成熟患者。使用RevMan进行荟萃分析，纳入具有临床同质性且在两个或多个研究中作为标准偏差的平均值的参数。不能包括在meta分析中的参数以描述性的方式呈现。结果筛选1825项研究后，共纳入18项研究，其中16项研究的参数纳入meta分析。本研究探讨了31个影响骨未成熟患者前交叉韧带损伤的膝关节形态学因素。meta分析发现，较小的缺口宽度指数（NWI）（0.25 vs. 0.26，平均差值：- 0.02 95%可信区间[CI]: - 0.03至- 0.01,p≤0.00001）更陡的MTS和LTS（4.8°vs. 3.6°（平均差值：0.55°95% CI: 0.09-1.01, p = 0.02）和4.3°vs. 2.8°（平均差值：2.04°95% CI: 0.75-3.32, p = 0.0003））以及较高的LTS/MTS比率是骨骼未成熟患者ACL损伤的危险因素。结论NWI小、MTS和LTS陡、LTS/MTS比值高是骨未成熟患者前交叉韧带损伤的相关形态学因素。证据等级三级。

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