Niskanen Raimo O., Paavilainen Pasi J., Jaakkola Mika, Korkala Olli L.
Department of Orthopaedics, Lahti Central Hospital, Lahti, Finland.
Arthroscopy. 2001 Mar;17(3):307-310. doi: 10.1053/jars.2001.21240.
There is controversy between the symptoms and signs of chondromalacia. Patellar chondromalacia has several clinical tests, whose reliability as a parameter of chondral damage is unclear. The purpose of this prospective study was to correlate the sensitivity, specificity, predictive values and accuracy of clinical patellar tests with the findings at arthroscopy. Type of Study: In this prospective study, 100 consecutive knees that were subjected to arthroscopy were examined. METHODS: Because of missing data, 85 of the 100 knees were included in the final analysis. There were 41 male and 44 female patients with an average age of 39 and 44 years, respectively. The clinical tests were the tracking test, the apprehension test, the patellar inhibition test, and the flexion test. These tests were compared with the arthroscopic findings of the patellar cartilage. The classification of Outerbridge was used for evaluation of the condition of the patellar cartilage. RESULTS: At arthroscopy, there were no patellar cartilage changes in 33 knees. Patellar chondromalacia was seen in 52 knees. Grade I changes were found in 9 knees, grade II in 21 knees, grade III in 17 knees, and grade IV in 5 knees. Among the 4 clinical tests, the sensitivity was best for the tracking test (56%). The flexion test had the greatest specificity (85%), but a low sensitivity (35%). None of the tests showed acceptable results in terms of both sensitivity and specificity. The predictive values and the accuracy of a test were low, too. CONCLUSIONS: The sensitivity and specificity, predictive values, and accuracy of a test were generally low, except perhaps the specificity of the flexion test. The current clinical tests seem to have little value as indicators of patellar chondral pathology.
髌骨软化症的症状和体征存在争议。髌股关节软骨软化症有多种临床检查方法，但其作为软骨损伤参数的可靠性尚不清楚。本前瞻性研究的目的是将临床髌股关节检查的敏感性、特异性、预测值和准确性与关节镜检查结果进行关联。研究类型：在这项前瞻性研究中，对100例连续接受关节镜检查的膝关节进行了检查。方法：由于数据缺失，最终分析纳入了100例膝关节中的85例。有41例男性和44例女性患者，平均年龄分别为39岁和44岁。临床检查包括轨迹试验、恐惧试验、髌骨抑制试验和屈曲试验。将这些检查与髌股关节软骨的关节镜检查结果进行比较。采用Outerbridge分类法评估髌股关节软骨的状况。结果：关节镜检查时，33例膝关节未见髌股关节软骨改变。52例膝关节出现髌股关节软骨软化症。9例为I级改变，21例为II级，17例为III级，5例为IV级。在4项临床检查中，轨迹试验的敏感性最佳（56%）。屈曲试验的特异性最高（85%），但敏感性较低（35%）。没有一项检查在敏感性和特异性方面都显示出可接受的结果。一项检查的预测值和准确性也较低。结论：除屈曲试验的特异性外，一项检查的敏感性、特异性、预测值和准确性总体较低。目前的临床检查似乎作为髌股关节软骨病变的指标价值不大。
