中国组织工程研究

中国组织工程研究 ›› 2026, Vol. 30 ›› Issue (12): 2986-2993.doi: 10.12307/2026.666

• 肌肉肌腱韧带组织构建 tissue construction of the muscle, tendon and ligament • 上一篇    下一篇

前交叉韧带损伤合并前外侧韧带损伤的危险因素分析

蔡逸帆1，闫振兴1，闫鹏安1，张  政1，滕元君1，2，3，耿  彬1，2，3，夏亚一1，2，3   

  1. 1兰州大学第二医院骨科，甘肃省兰州市  730030；2甘肃省骨科临床医学研究中心，甘肃省兰州市  730030；3甘肃省智能骨科行业技术中心，甘肃省兰州市  730030

  • 收稿日期:2025-03-14 接受日期:2025-08-16 出版日期:2026-04-28 发布日期:2025-09-28
  • 通讯作者: 夏亚一，博士，教授，主任医师，博士生导师，兰州大学第二医院骨科，甘肃省兰州市 730030；甘肃省骨科临床医学研究中心，甘肃省兰州市 730030；甘肃省智能骨科行业技术中心，甘肃省兰州市 730030
  • 作者简介:蔡逸帆，男，1999年生，新疆维吾尔自治区乌鲁木齐市人，回族，兰州大学在读硕士，主要从事关节外科研究。
  • 基金资助:
    国家自然科学基金项目(82360436，82060405)，项目负责人：夏亚一；国家自然科学基金项目(81960403)，项目负责人：耿彬

Risk factors of anterolateral ligament injury following anterior cruciate ligament injury

Cai Yifan1, Yan Zhenxing1, Yan Pengan1, Zhang Zheng1, Teng Yuanjun1, 2, 3, Geng Bin1, 2, 3, Xia Yayi1, 2, 3   

  1. 1Department of Orthopedics, the Second Hospital of Lanzhou University, Lanzhou 730030, Gansu Province, China; 2Orthopaedic Clinical Research Center of Gansu Province, Lanzhou 730030, Gansu Province, China; 3Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou 730030, Gansu Province, China
  • Received:2025-03-14 Accepted:2025-08-16 Online:2026-04-28 Published:2025-09-28
  • Contact: Xia Yayi, MD, Professor, Chief physician, Doctoral supervisor, Department of Orthopedics, the Second Hospital of Lanzhou University, Lanzhou 730030, Gansu Province, China; Orthopaedic Clinical Research Center of Gansu Province, Lanzhou 730030, Gansu Province, China; Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou 730030, Gansu Province, China
  • About author:Cai Yifan, MS candidate, Department of Orthopedics, the Second Hospital of Lanzhou University, Lanzhou 730030, Gansu Province, China
  • Supported by:
    National Natural Science Foundation of China, Nos. 81960403 (to GB), 82360436 (to XYY), and 82060405 (to XYY)

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摘要：


文题释义：
前交叉韧带损伤：70%前交叉韧带损伤属于运动性损伤，主要由膝关节过度外翻、外旋和过伸造成，损伤后导致膝关节不稳定，进一步增加关节软骨、韧带和半月板损伤的风险，远期可发生膝关节退行性变，如创伤性关节炎，严重影响患者的生活质量。早期行前交叉韧带重建术是有效的治疗方法。
前外侧韧带：膝关节前外侧韧带大致起自股骨外上髁，止于胫骨近端前外侧，分为三部分结构：股骨、半月板和胫骨部，MRI是诊断前外侧韧带损伤的有效手段。前外侧韧带和前交叉韧带通过协同作用来维持膝关节稳定性。

背景：前交叉韧带重建术是治疗前交叉韧带损伤的标准疗法，但单纯前交叉韧带重建术后仍存在膝关节旋转不稳定，目前大部分研究认为，联合前外侧韧带重建可有效改善这一问题。然而，病因学方面缺乏针对合并损伤的危险因素研究，导致此类患者在早期诊断、手术决策及预防半月板和韧带再损伤方面的参考指标尚不明确。
目的：探究前交叉韧带损伤合并前外侧韧带损伤的危险因素。
方法：回顾性分析2023年1月至2024年1月经关节镜诊断为非接触性前交叉韧带损伤300例患者，通过术前MRI识别前外侧韧带损伤情况，其中41例患者纳入前外侧韧带损伤组，并按年龄和性别1∶2匹配82例患者纳入前外侧韧带未损伤组。在MRI上评估股骨和胫骨的解剖学特征，包括股骨髁间窝宽度、双髁宽度、股骨髁间窝宽度指数、内侧胫骨平台深度、静态胫骨前移、外侧胫骨平台后倾角、内侧胫骨平台后倾角，以及内外侧半月板和内外侧副韧带的损伤情况。采用多因素Logistic回归模型分析潜在危险因素，采用简单效应检验分析外侧半月板和外侧胫骨平台后倾角间的协同作用。
结果与结论：与前外侧韧带未损伤组对比，前外侧韧带损伤组的外侧半月板损伤(P < 0.001)、静态胫骨前移程度(P=0.009)和外侧胫骨平台后倾角(P=0.042)均存在显著差异。多因素Logistic回归分析进一步验证了外侧半月板损伤(OR=7.36；95%CI：2.78-19.48；P < 0.001)、静态胫骨前移(OR=1.16；95%CI：1.03-1.29；P=0.008)和外侧胫骨平台后倾角(OR=1.13；95%CI：1.01-1.27；P=0.040)是前交叉韧带损伤伴随前外侧韧带损伤的独立危险因素。简单效应检验分析显示在4° < 外侧胫骨平台后倾角≤10°(P=0.007)和外侧胫骨平台后倾角> 10°(P < 0.001)时与外侧半月板对合并损伤的影响具有协同作用。研究结果表明，对于前交叉韧带损伤患者，外侧半月板损伤、外侧胫骨平台后倾角增大及静态胫骨前移是合并前外侧韧带损伤的独立危险因素，且外侧半月板损伤和外侧胫骨平台后倾角增大具有协同效应。

https://orcid.org/0000-0001-9351-9802(夏亚一)


中国组织工程研究杂志出版内容重点：干细胞；骨髓干细胞；造血干细胞；脂肪干细胞；肿瘤干细胞；胚胎干细胞；脐带脐血干细胞；干细胞诱导；干细胞分化；组织工程

关键词: 前交叉韧带损伤, 前外侧韧带损伤, 外侧半月板, 外侧胫骨平台后倾角, 静态胫骨前移, 协同作用

Abstract: BACKGROUND: Anterior cruciate ligament reconstruction is the standard treatment for anterior cruciate ligament injuries; however, residual rotational instability persists postoperatively. While combined anterolateral ligament reconstruction is increasingly advocated to address this issue, the etiological risk factors for concomitant anterolateral ligament injuries remain poorly defined, limiting early diagnosis, surgical decision-making, and prevention of secondary meniscal/ligamentous injuries.
OBJECTIVE: To identify the risk factors for concomitant anterolateral ligament injuries in patients with anterior cruciate ligament injury.
METHODS: This retrospective study analyzed 300 patients diagnosed arthroscopically with non-contact anterior cruciate ligament injuries (January 2023 to January 2024). Based on preoperative magnetic resonance imaging, 41 patients with anterolateral ligament injuries were included as the injury group and 1:2 matched with 82 controls (no anterolateral ligament injury). Anatomical parameters were assessed via magnetic resonance imaging, including femoral notch width, bicondylar width, notch width index, medial tibial depth, static anterior tibial subluxation, lateral tibial slope, medial tibial slope, and meniscal/collateral ligament status. Multivariate logistic regression and simple effects analysis were used to evaluate risk factors and synergistic interactions.
RESULTS AND CONCLUSION: Compared with the control group, the anterolateral ligament injury group exhibited significantly higher rates of lateral meniscal tears (P < 0.001), greater static anterior tibial subluxation (P=0.009), and increased lateral tibial slope (P=0.042). Multivariate Logistic analysis confirmed lateral meniscal injury [odds ratio (OR)=7.36; 95% confidence interval (CI): 2.78–19.48; P < 0.001), static anterior tibial subluxation (OR=1.16; 95% CI: 1.03–1.29; P=0.008), and lateral tibial slope (OR=1.13; 95% CI: 1.01–1.27; P=0.040) as independent risk factors. Simple effects analysis showed that a synergistic effect between lateral meniscal injury and lateral tibial slope was observed at 4° < lateral tibial slope ≤ 10° (P=0.007) and lateral tibial slope > 10° (P < 0.001). To conclude, lateral meniscal injury, elevated lateral tibial slope, and static anterior tibial subluxation are independent risk factors for concomitant anterolateral ligament injuries in anterior cruciate ligament-deficient knees, with synergistic interactions between elevated lateral tibial slope and lateral meniscal injury. 

Key words: anterior cruciate ligament injury, anterolateral ligament injury, lateral meniscus, lateral tibial slope, static anterior tibial subluxation, synergistic effect 

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