Nourissat G, Beaufils P, Charrois O, Selmi T Ait Si, Thoreux P, Moyen B, Cassard X
Centre Hospitalier A Mignot, Versailles, France.
Knee Surg Sports Traumatol Arthrosc. 2008 May;16(5):482-6. doi: 10.1007/s00167-007-0479-5.
Prediction of meniscus reparability is useful for surgeons to optimise surgical scheduling and to inform patients about postoperative management. This study was designed to determine the accuracy of MRI in predicting the reparability of longitudinal full-thickness meniscus lesions. We studied 100 MRIs of longitudinal full-thickness medial or lateral meniscus lesions located from the meniscosynovial junction to the axial part of the meniscus. The MRI criteria of reparability were a peripheral rim smaller than 4 mm and a lesion longer than 10 mm. At arthroscopy the menisci were considered as reparable when the lesion was located in red-red or red-white zones and when it was more than 1 cm in length. A heterogeneous or homogeneous aspect of the meniscus body was also considered. The length of the meniscus lesion averaged 17.6 mm and the thickness of the rim 3.4 mm. A heterogeneous signal of the axial fragment and of the rim was found in 11 cases and in 48 cases, respectively. In 90 cases, there was no difference between the MRI-predicted reparability and the arthroscopic findings. Global sensitivity of MRI to determine reparability of full-thickness meniscus lesions was 94%, increasing to 96% for the medial meniscus and dropping to 83% for the lateral meniscus. Global specificity was 81%, and was higher for the lateral meniscus (90%) than for the medial one (82%). Global positive predictive value was 0.94 and global negative predictive value was 0.82. A heterogeneous aspect of the rim did not compromise arthroscopic reparability whereas a heterogeneous aspect of the axial fragment indicated an irreparable meniscus. The described MRI criteria can predict meniscus reparability. Their accuracy is limited for lateral meniscus lesions close to the popliteal hiatus and for very young active patients in whom repair of white-white lesions can be attempted. Longitudinal full-thickness meniscus lesions are a good indication for repair in young active patients.
半月板可修复性的预测有助于外科医生优化手术安排，并向患者告知术后管理情况。本研究旨在确定MRI在预测纵向全层半月板损伤可修复性方面的准确性。我们研究了100例纵向全层内侧或外侧半月板损伤的MRI，这些损伤位于半月板滑膜交界处至半月板轴向部分。可修复性的MRI标准为外周缘小于4mm且损伤长度大于10mm。在关节镜检查时，当损伤位于红-红或红-白区域且长度超过1cm时，半月板被认为可修复。半月板体部的不均匀或均匀外观也被考虑在内。半月板损伤的长度平均为17.6mm，边缘厚度为3.4mm。分别在11例和48例中发现轴向碎片和边缘有不均匀信号。在90例中，MRI预测的可修复性与关节镜检查结果之间没有差异。MRI确定全层半月板损伤可修复性的总体敏感性为94%，内侧半月板增至96%，外侧半月板降至83%。总体特异性为81%，外侧半月板（90%）高于内侧半月板（82%）。总体阳性预测值为0.94，总体阴性预测值为0.82。边缘的不均匀外观并不影响关节镜下的可修复性，而轴向碎片的不均匀外观表明半月板不可修复。所描述的MRI标准可以预测半月板的可修复性。对于靠近腘肌腱裂孔的外侧半月板损伤以及对于可以尝试修复白-白损伤的非常年轻的活跃患者，其准确性有限。纵向全层半月板损伤是年轻活跃患者进行修复的良好指征。
