Huegli Rolf W, Moelleken Sonja M C, Stork Alexander, Bonel Harald M, Bredella Miriam A, Meckel Stephan, Genant Harry K, Tirman Phillip F J
Department of Radiology, University Hospital of Basel, Petersgraben 4, Basel 4031, Switzerland.
Eur J Radiol. 2005 Jan;53(1):90-5. doi: 10.1016/j.ejrad.2004.02.001.
To assess and describe post-traumatic articular cartilage injuries isolated to the trochlear groove and provide insight into potential mechanism of injury.
We retrospectively evaluated MR imaging findings of all knee MRIs performed at our institution over the last 2 years (2450). Thirty patients met the criteria of a cartilage injury confined to the trochlear groove. In 15 cases, which were included in our study, arthroscopic correlation was available. Each plane was evaluated and graded for the presence and appearance of articular cartilage defects using a standard arthroscopic grading scheme adapted to MR imaging. Any additional pathological derangement was documented and information about the mechanism of injury was retrieved by chart review.
In all cases the cartilaginous injury was well demonstrated on MRI. In 13 patients additional pathological findings could be observed. The most frequently associated injury was a meniscal tear in nine patients. In eight cases, the arthroscopic grading of the trochlear injury matched exactly with the MRI findings. In the remaining seven cases, the discrepancy between MRI and arthroscopy was never higher than one grade. In 13 out of 15 of patients trauma mechanism could be evaluated. Twelve patients suffered an indirect twisting injury and one suffered a direct trauma to their knee.
The findings of this study demonstrate that MR imaging allows reliable grading of isolated injury to the trochlear groove cartilage and assists in directing surgical diagnosis and treatment. These injuries may be the only hyaline cartilage injury in the knee and meniscal tears are a frequently associated finding. Therefore, it is important to search specifically for cartilage injuries of the trochlear groove in patients with anterior knee pain, even if other coexistent pathology could potentially explain the patient's symptoms.
评估并描述单纯累及滑车沟的创伤性关节软骨损伤,并深入了解潜在的损伤机制。
我们回顾性评估了过去两年在我院进行的所有膝关节MRI检查(共2450例)的影像结果。30例患者符合滑车沟局限性软骨损伤的标准。其中15例纳入本研究,可进行关节镜检查对照。使用适用于MRI的标准关节镜分级方案,对每个平面的关节软骨缺损的存在情况及外观进行评估和分级。记录任何其他病理紊乱情况,并通过查阅病历获取损伤机制的相关信息。
所有病例中,软骨损伤在MRI上均显示良好。13例患者可观察到其他病理表现。最常见的相关损伤是9例患者的半月板撕裂。8例患者滑车损伤的关节镜分级与MRI结果完全匹配。其余7例中,MRI与关节镜检查结果的差异从未超过一个等级。15例患者中有13例可评估创伤机制。12例患者遭受间接扭转损伤,1例患者膝关节受到直接创伤。
本研究结果表明,MRI能够对滑车沟软骨的单纯损伤进行可靠分级,并有助于指导手术诊断和治疗。这些损伤可能是膝关节中唯一的透明软骨损伤,半月板撕裂是常见的相关表现。因此,对于前膝痛患者,即使其他并存的病理情况可能解释患者的症状,也应特别检查滑车沟的软骨损伤。