探讨前交叉韧带断裂后增加内外侧半月板撕裂以及关节软骨损伤风险的相关因素。

回顾性分析2011年3月至2018年12月期间，因前交叉韧带断裂在南京鼓楼医院骨科关节疾病诊疗中心行韧带重建术患者的临床资料，探讨受伤时长、患者性别、年龄以及体质量指数（BMI）与继发性内外侧半月板和关节软骨损伤的相关性。根据受伤时长，将患者分成≤1个月和>1个月组；根据软骨损伤Outer-bridge分度法，将患者则分成轻度损伤（0级和1级）和重度损伤（2~4级），根据患者年龄，将患者分成≤20岁和>20岁组。根据患者BMI将患者分成BMI≤24和BMI>24组。各组间比较采用χ²检验。差异具有统计学意义的变量进行Logistic多因素回归分析。

本研究共纳入607例患者，其中男性459例，女性148例。平均年龄29岁（10~52岁），平均BMI为21.3 kg/m²，平均受伤时长1年5个月（1 d~20年）。138例患者存在单纯内侧半月板撕裂，206例患者存在单纯外侧半月板撕裂，19.3%（117/607）的患者存在关节软骨的损伤。多因素分析表明，BMI和性别是外侧半月板损伤的危险因素［P=0.040，OR：1.21，95%可信区间（CI）：0.23~1.12；P=0.005，OR：0.50，95%CI：0.34~0.73］。BMI、受伤时长和性别是内侧半月板损伤的危险因素（P=0.031，OR：1.32，95%CI：1.02~1.54；P=0.009，OR：1.63，95%CI：1.16~2.28；P=0.029，OR：0.64，95%CI：0.43~0.96）。BMI和受伤时长是软骨损伤及其严重程度的危险因素（BMI：P<0.001，OR：2.31，95%CI：1.04~2.36；P<0.001，OR：2.62，95%CI：0.68~2.55；受伤时长：P<0.001，OR：2.22，95%CI：1.39~3.55；P=0.007，OR：0.54，95%CI：0.34~0.86）。

前交叉韧带断裂后，随着受伤时长增加，内外侧半月板及关节软骨损伤风险显著增加，所以患者应积极尽早手术。此外由于男性患者内外侧半月板损伤风险较女性患者增加，术前谈话及制定手术计划时应充分考虑到此危险因素，对于BMI>24者，由于其内外侧半月板及关节软骨较BMI≤24者损伤加重，该类患者受伤后应该尤其重视。

To identify the factors associated with secondary meniscal and chondral injuries after anterior cruciate ligament (ACL) injury.

We retrospectively collected the data of all patients who underwent ACL reconstruction for ACL injury at our institution between March 2011 and December 2018 and investigated the relationship between the incidence of meniscal and chondral injuries and the duration of injury, gender, age, and body mass index (BMI). Subjects were divided into groups based on the injury-to-surgery interval (≤1 month vs >1 month), Outer-bridge classification (mild injury [grades 0 and 1] vs severe injury [grades 2, 3, and 4]), age (≤20 years old vs >20 years old), and BMI (>24 kg/m² vs 24 kg/m²). The Chi-squared test was used to compare the incidence of meniscal and chondral injuries between groups, and factors with a P-value less than 0.05 were further analyzed using Logistic regression models.

In total, 607 patients (459 males and 148 females) were included this study. The average age was 29 years old (range, 10-52 years old). The average BMI was 21.3 kg/m². The mean duration from injury to surgery was 1.5 months, with a range from one day to 20 years. Approximately 138 patients suffered medial meniscus tears, 206 patients suffered lateral meniscal injuries, and 19.3% (117/607) suffered intra-articular cartilage lesions. Multivariable analysis demonstrated that BMI and sex were risk factors for lateral meniscus injury (P=0.040, odds ratio [OR]=1.21, 95%CI: 0.23-1.12; P=0.005, OR=0.50, 95%CI: 0.34-0.73). BMI, duration of injury, and gender were the risk factors for medial meniscus injury (P=0.0031, OR=1.32, 95%CI: 1.02-1.54; P=0.009, OR=1.63, 95%CI: 1.16-2.28; P=0.029, OR=0.64, 95%CI: 0.43-0.96). BMI and duration of injury were the risk factors for cartilage damage and its severity (BMI: P<0.001, OR=2.31, 95%CI: 1.04-2.36; P<0.001, OR=2.62, 95%CI: 0.68-2.55; duration of injury: P<0.001, OR=2.22, 95%CI: 1.39-3.55; P=0.007, OR=0.54, 95%CI: 0.34-0.86).

To reduce the risk for meniscal and chondral injuries, as well as the severity of cartilage lesions, ACL reconstruction should be performed actively once injury occurs. In addition, male gender as a risk factor for meniscal damage should be considered when making operation plan and giving preoperative discussions. Surgeons should pay more attention to patients with a BMI>24, because BMI is associated with an obvisouly increased risk of intra-articular lesions.