Gebhard F, Authenrieth M, Strecker W, Kinzl L, Hehl G
Department of Traumatology, Hand- and Reconstructive Surgery, University of Ulm, Germany.
Knee Surg Sports Traumatol Arthrosc. 1999;7(3):166-72. doi: 10.1007/s001670050142.
Ultrasound is not so far a standard procedure to visualize the anterior drawer following anterior cruciate ligament (ACL) lesions. This is because the described techniques are either technically difficult or depend on the experience of the performer and are not standardized. The purpose of this prospective analysis on ACL intact, ACL deficient and ACL reconstructed knees was to compare the diagnostic accuracy of prone ultrasonographic Lachman testing with KT-1000 measurements in the same study population. Our technique is based on a prone position of the patient. The thigh lies on the table surface such that the patella has no contact. The lower leg is placed on a roll in the ankle area and flexed to 30 degrees . The transducer (5 MHz) is positioned over the medial aspect of the popliteal fossa to visualize the femoral condyle as well as the tibial head. Under ultrasound control the lower leg is manually lifted as far the thigh stays in contact with the surface defining the start position. The lower leg is then released and drawn by gravity into the anterior drawer position, the final position. The distance between the posterior tangent from the medial femoral condyle to the medial tibial plateau was registered by three independent ultrasound measurements of the injured knee. The uninvolved opposite knee served as an internal control. The same procedure was done using a KT-1000 device (89 and 133 Newton and manual maximum force). The patients were split into two groups: acute injury (A), and (B) 6 months following ACL repair with a patellar tendon graft. All patients then underwent arthroscopy. In group A with acute ACL lesions the anterior drawer resulted in 14.1 mm (+/- 3.5) and was significantly (P < 0.001) different from the contralateral knee (7.7 mm +/- 2.9). The KT 1000 showed a comparable difference with 14.4 mm (+/- 3.9) for the injured knee and 8.3 mm (+/- 3.4) for the uninjured (P < 0.001). Sonometrically, group B patients showed no clear difference between the repaired (9.9 mm +/- 2.7) knee and its control (8.1 mm +/- 2.5). This was found for the KT-1000 results as well. The results derived from the ultrasound evaluation of the anterior drawer correlated well with those from the KT-1000 (r = 0.46). Based on a minimum intra-individual difference of 5 mm in the ultrasound measured anterior drawer, the sensitivity of the test in group A resulted in 0.96, and the specificity in 0.98. The described technique is reproducible, painless and easy to perform in order to evaluate acute ACL tears using any commercially available ultrasound device. The reproducibility is similar to the KT-1000 device. We recommend this technique for use in cases of acute ACL tears as well as in the follow-up of ACL repair.
迄今为止，超声检查尚未成为可视化前交叉韧带（ACL）损伤后前抽屉试验的标准程序。这是因为所描述的技术要么在技术上具有难度，要么依赖于操作者的经验，且未标准化。本前瞻性分析针对ACL完整、ACL缺失和ACL重建的膝关节，目的是在同一研究人群中比较俯卧位超声Lachman试验与KT - 1000测量的诊断准确性。我们的技术基于患者的俯卧位。大腿置于桌面，使髌骨不接触桌面。小腿在踝关节区域放置于一个卷轴上，并屈曲至30度。将换能器（5兆赫）置于腘窝内侧，以可视化股骨髁和胫骨头。在超声引导下，手动抬起小腿，直至大腿与定义起始位置的表面保持接触。然后松开小腿，使其在重力作用下进入前抽屉位置，即最终位置。通过对受伤膝关节进行三次独立的超声测量，记录从股骨内侧髁后切线到胫骨内侧平台的距离。未受伤的对侧膝关节作为内部对照。使用KT - 1000设备（89牛顿和133牛顿以及手动最大力）进行相同的操作。患者分为两组：急性损伤组（A）和ACL用髌腱移植修复6个月后的组（B）。所有患者随后均接受关节镜检查。在急性ACL损伤的A组中，前抽屉试验结果为14.1毫米（±3.5），与对侧膝关节（7.7毫米±2.9）有显著差异（P < 0.001）。KT - 1000显示出类似的差异，受伤膝关节为14.4毫米（±3.9），未受伤膝关节为8.3毫米（±3.4）（P < 0.001）。在B组患者中，超声测量显示修复后的膝关节（9.9毫米±2.7）与其对照膝关节（8.1毫米±2.5）之间无明显差异。KT - 1000的结果也是如此。前抽屉试验的超声评估结果与KT - 1000的结果相关性良好（r = 0.46）。基于超声测量的前抽屉试验中个体内最小差异为5毫米，A组试验的敏感性为0.96，特异性为0.98。所描述的技术具有可重复性、无痛且易于操作，可使用任何市售超声设备评估急性ACL撕裂。其可重复性与KT - 1000设备相似。我们建议将该技术用于急性ACL撕裂病例以及ACL修复后的随访。
