Steckel Hanno, Vadala Gianluca, Davis Denise, Musahl Volker, Fu Freddie H
Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA 15213, USA.
Knee Surg Sports Traumatol Arthrosc. 2007 Sep;15(9):1066-71. doi: 10.1007/s00167-007-0337-5. Epub 2007 May 12.
Magnetic resonance imaging (MRI) is the most commonly used diagnostic imaging procedure for suspected injuries to the anterior cruciate ligament (ACL). However, MRI has less utility for the evaluation of partial ACL tears. The goal of this study was to evaluate the possibility of distinguishing partial ACL tears applying the double bundle concept by dividing the ACL anatomy in the anteromedial (AM) and posterolateral bundle (PL). Six human cadaver knees were used in this laboratory study. The protocol consisted of sagittal, oblique coronal, and oblique sagittal proton-density-weighted fast spin echo sequences. After MRI the AM and the PL bundle were severed to mimic different partial ACL rupture patterns. MRI scanning of each knee was repeated, to record the quantitative parameters tilt and ACL angles and discontinuity as a nonquantitative parameter. Three orthopaedic surgeons and two radiologists were enlisted as blinded observers to evaluate the images. The transection patterns could be differentiated by evaluating discontinuity both in the paracoronal and in the sagittal plane. Evaluating the transection patterns, the AM bundle reached a better result in both planes compared to the PL bundle and the paracoronal plane had a better result in assessing the transection patterns compared to the sagittal plane for the PL bundle. Partial ACL transections could predictably be recognized on oblique sagittal and oblique coronal planes utilizing 3-T MRI technology. This concept allows a more precise description of ACL rupture patterns and might lead to a more distinctive approach for reconstructive surgery. The presurgical planning could be improved by applying a treatment algorithm based on a description of each bundle as intact or ruptured, leading to a reconstruction of the torn and a preservation of the intact bundle.
磁共振成像（MRI）是怀疑前交叉韧带（ACL）损伤时最常用的诊断成像方法。然而，MRI在评估部分ACL撕裂方面的效用较低。本研究的目的是通过将ACL解剖结构分为前内侧（AM）束和后外侧束（PL）束，评估应用双束概念区分部分ACL撕裂的可能性。本实验室研究使用了6具人体尸体膝关节。该方案包括矢状面、斜冠状面和斜矢状面质子密度加权快速自旋回波序列。MRI检查后，切断AM束和PL束以模拟不同的部分ACL断裂模式。对每个膝关节重复进行MRI扫描，记录定量参数倾斜度和ACL角度以及作为非定量参数的连续性中断情况。招募了三名骨科医生和两名放射科医生作为盲法观察者来评估图像。通过评估副冠状面和矢状面的连续性中断情况，可以区分横断模式。在评估横断模式时，与PL束相比，AM束在两个平面上都取得了更好的结果，并且对于PL束，与矢状面相比，副冠状面在评估横断模式方面取得了更好的结果。利用3-T MRI技术，在斜矢状面和斜冠状面上可以预测性地识别部分ACL横断。这一概念允许对ACL断裂模式进行更精确的描述，并可能导致重建手术采用更具特色的方法。通过应用基于描述每个束完整或断裂的治疗算法，可以改进术前规划，从而对撕裂的束进行重建并保留完整的束。
