| Objective: The purpose of this study was to measure each anatomical morphological indicator of knee joints with MRI images,and analyze the correlation between the abnormalities of each anatomical morphological indicator of knee joints and anterior cruciate ligament（ACL）injury,understand the possible causes of ACL injury,and provide a certain degree of reference for its prevention,treatment and diagnosis.Methods: A total of 140 patients who were admitted to the Department of Joint Surgery,No.904 Hospital of United Logistics Support Forces for knee injury or discomfort caused by non-contact mechanism from January 2016 to March 2021 were divided into ACL intact group and ACL injury group,70 cases in ACL intact group,48 males and 22 females,with the average age of 29.10±6.74 years old.There were 70 cases in ACL injury group,including 50 males and 20 females,with the average age of 29.93±6.94 years old.The injury groups of ACL were subdivided into complete ACL tear group and partial ACL tear group.There were 49 cases（37 males and 12 females）in the complete ACL tear group,with the average age of 29.34±7.21 years old.There were 21 cases（13 males and 8 females）in the partial ACL tear group,with the average age of 30.31±6.41 years old.MRI image data of each group were collected,and the notch width index（NWI）,Blumensaat’s line in angle,BIA),the shape of the notch,the lateral femoral condyle index（LFCI）,the lateral femoral condyle ratio（LFCR）,ratio of height of lateral femoral condyle to anteroposterior diameter（HAPR）,tibial intercondylar spine width,TSW),lateral tibial slope（LPTS）,medial tibial slope,MPTS),the ratio of tibial intercondylar spine to intercondylar notch width（TSNR）,to explore the correlation between the above anatomical morphological indicators of the knee joint and ACL injury,as well as the differences of each morphological index between patients with partial or complete ACL tear and the accuracy of its assessment of the risk of ACL injury.Results: 1.Compared with the intact ACL group and the injured ACL group,there were no significant differences in age,BMI,gender and gender between the two groups（P >0.05）;NWI,LFCI,HAPR,TSW,and TSNR of the ACL injury group were lower than those of the ACL complete group,and the differences were statistically significant（P <0.05）.The levels of BIA,LFCR,LPTS,and MPTS in the ACL injury group were higher than those in the intact ACL group,and the differences were statistically significant（P <0.05）.Type A intercondylar notch was more common in the ACL injury group,and U-shaped and W-shaped notches were more common in the intact ACL group,and the difference was statistically significant（P < 0.05）.2.Compared with the general information of each morphological indicator in the intact ACL group,the completely torn ACL group,and the partially torn ACL group,there was no significant difference in age,BMI,gender,or gender among the three groups（P > 0.05）.The differences of NWI,BIA,LFCI,LFCR,HAPR,TSW,LPTS,MPTS,TSNR,and notch shape among the three groups were statistically significant（P < 0.05）.3.The morphological indicators of complete ACL group,complete ACL tear group and partial ACL tear group were compared between two groups.The NWI,BIA,LFCI,LFCR,HAPR,TSW,MPTS,and TSNR of complete ACL group were significantly different from those of complete ACL tear group and partial ACL tear group（P < 0.05）.The NWI,BIA,LFCI,LFCR,HAPR,TSW,MPTS,and TSNR of complete ACL tear group was not significantly different from that of partial ACL tear group（P > 0.05）.The differences of LPTS in the complete ACL group and the complete ACL tear group were both statistically significant（P <0.05）,while the LPTS in the complete ACL group were not significantly different from the partial ACL tear group（P > 0.05）.The LPTS in the complete ACL tear group were not significantly different from the partial ACL tear group（P > 0.05）.4.Single factor binary Logistic regression analysis and multivariate binary Logistic regression analysis were performed on each knee joint anatomical morphology indicator,and the results showed that there was a correlation between NWI and ACL injury（P < 0.05）,with OR value of 0.018;There was a correlation between BIA and ACL injury（P <0.05）,and OR value was 9.855.There was a correlation between LFCI and ACL injury（P < 0.05）,and OR value was 0.219.There was a correlation between LFCR and ACL injury（P < 0.05）,and OR value was 44.233.There was a correlation between HAPR and ACL injury（P < 0.05）,and OR value was 0.123.There was a correlation between LPTS and ACL injury（P < 0.05）,and OR value was 11.657.There was a correlation between TSNR and ACL injury（P < 0.05）,and OR value was 0.199.There was a correlation between the A-shaped notch and ACL injury（P < 0.05）,and the OR value was 9.517.There was no correlation between TSW,MPTS and ACL injury（P > 0.05）.5.ROC curve analysis was performed on each anatomical morphological index related to ACL injury.The results showed that the optimal threshold of NWI was 0.28,the sensitivity was 87.1%,the specificity was 91.4%,and AUC was 0.876.The optimal threshold of BIA was 33.81,the sensitivity was 67.1%,the specificity was 87.1%,and the AUC was 0.825.The optimal critical value for LFCI was 0.71,sensitivity 72.9%,specificity 85.7%,and AUC 0.876.The optimal cutoff value of LFCR was 0.61,the sensitivity was 88.6%,the specificity was 80.0%,and the AUC was 0.876.The optimal critical value of HAPR was 0.33,sensitivity 82.9%,specificity 72.9%,and AUC 0.758.The optimal threshold of LPTS was 6.38,the sensitivity was 62.9%,the specificity was64.3%,and the AUC was 0.665.The optimal critical values for TSNR were 0.66,sensitivity 68.6%,specificity 70.0%,and AUC 0.718.Conclusion: Lower NWI,higher BIA,lower LFCI,higher LFCR,lower HAPR,higher LPTS,lower TSNR,and A-shaped notch are all risk factors for ACL injury.However,TSW and MPTS are not risk factors for ACL injury,and the possible injury mode of ACL can not be determined by abnormal morphological indicators of knee joint.The correlation between lower TSNR and ACL injury proves that the poor matching between tibial intercondylar eminence and femoral intercondylar notch is one of the risk factors for ACL injury.NWI is the most accurate indicator for assessing the risk of ACL injury.When the NWI is less than 0.28,the predictive sensitivity and specificity are87.1% and 91.4%,respectively.However,it needs to be jointly assessed in combination with multiple morphological indicators of the knee joint. |
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