Diagnostic value of imaging model for anterior cruciate ligament injury in patients with gune varus osteoarthritis
Objective To explore the value of nomogram model based quantitative parameters of multi-position X-ray imaging for diagnosis of anterior cruciate ligament(ACL)injury in patients with genu varus osteoarthritis(OA).Methods From January 2021 to January 2023,a total of 108 patients who initial diagnosed with unilateral genu varus OA were enrolled,which in-cluded 62 males and 46 females,aged 51-81 years old with mean age of 66.6 years old(standard deviation 9.7 years old).The lesion was located on the left side in 54 cases and on the right side in 54 cases.According to results of preoperative Lachman test and MRI examination,all of them were divided into ACL intact group and ACL defect group.All of them un-derwent X-ray standardized examination in anterior-posterior(AP)standing position,lateral position and hip-to-ankle AP standing position.The distance ratio of the maximum wear point of proximal tibia and margo anteriortibia％(MWPPT％),tib-ial spine sign(TSS),coronal tibiofemoral subluxation(CTFS),hip-knee-ankle angle(HKA),mechanical proximal tibial angle(mPTA),mechanical lateral distal femoral angle(mLDFA)and angle between tibial anatomical axis and tibial plateu(posterior tibial slope,PTS)were measured.Results Among 108 patients,there were 31 cases in ACL defect group,and 77 in A-CL intact group.The MWPPT％,CTFS,HKA and PTS in defect group were significantly higher than those in intact group[(58.6±6.6)％vs(46.5±6.3)％,(6.3±1.7)mm vs(5.1±1.3)mm,(10.5±3.6)° vs(7.2±2.6)°,(10.6±1.5)° vs(8.7±1.2)°.P＜0.001].The increased MWPPT％[odds ratio(OR)=1.526,95％confidence interval(CI)=1.234-1.902,P＜0.001],HKA(OR=1.302,95％CI=1.112-1.756,P＜0.001)and PTS(OR=2.232,95％CI=1.568-2.658,P＜0.001)were powerful predictors of ACL injury in OA varus patients.The inter-observer and intra-observer intra-class correlation coefficients(ICC)of MWPPT％,HKA and PTS were all greater than 0.856,which indicated its good repeatability.After establishment of nomogram model,the total score was 220.The receiver operating characteristic(ROC)curve showed that the area under curve(AUC)of nomogram model for diagnosing of ACL injury was 0.939(95％CI=0.876-0.976,P＜0.001),which was signifi-cantly higher than that of MWPPT％,HKA and PTS alone.The optimal cut-off values of MWPPT％,HKA and PTS were 52.9％,8.8° and 9.4°,respectively.Conclusion It is demonstrated that preoperative Lachman test and MRI examination could effectively evaluate intraoperative ACL status.The MWPPT％,HKA and PTS obtained from multi-position X-ray measurement could effectively predict ACL injury in OA patients,and established nomogram model shows higher diagnostic efficiency than single index,which has important clinical application potential.
varus kneeosteoarthritisanterior cruciate ligamentimagingnomograph model
NETL
NSTL
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