Orthopaedic Surgery and Traumatology Department, Rouen Teaching Medical Center, 1, rue de Germont, 76031 Rouen cedex, France.
Orthop Traumatol Surg Res. 2011 Feb;97(1):34-43. doi: 10.1016/j.otsr.2010.08.004. Epub 2010 Dec 18.
The clinical diagnosis of the anterior cruciate ligament (ACL) tear is based on demonstrating anterior subluxation of the tibia on the femur. In any of the following perspectives, diagnostic (cutoff value confirming rupture), prognostic (treatment efficacy), and therapeutic (laxity influencing the treatment), this laxity can be measured on stress X-rays.
The diagnostic value of dynamic radiographs is low for ACL rupture. Passive Telos(®) X-rays have better diagnostic value, better radiologic quality, and are easier to carry out than active Franklin-type X-rays.
A cohort of 112 patients (28 females, 84 males; mean age, 33.7 years [range, 18-72 years]) with an indication for knee arthroscopy were studied prospectively. Before undergoing the arthroscopic treatment, two series of images of both knees were taken: one series of passive anterior drawer dynamic X-rays on a Telos(®) device at 250 N and a series of active anterior drawer dynamic X-rays according to Franklin (contraction of the quadriceps against 7 kg of weight at the ankle). The arthroscopic evaluation of the ACL (reference status) was compared to the anterior laxity measurements (absolute and differential) of each knee compartment (medial, lateral, and average) to determine the diagnostic value of the two radiological tests.
We found 70 patients with an "arthroscopically ruptured ACL", 32 with an "arthroscopically healthy ACL", and 10 with a "partial rupture". The measurement of the anterior drawer values on the dynamic X-rays (active and passive) by two independent observers was reliable and reproducible (ICC>0.80), particularly when using the medial compartment (ICC=0.96) and the differential values eliminating the interobserver measurement error and interindividual laxity variations. In terms of X-ray technique, the active images were more frequently painful and the radiographic result showed less good quality than the Telos images. The anterior drawer values in the "healthy ACL" group were significantly less than in the "ruptured ACL" group for the Telos(®) images, whether the measurements were absolute or differential. For the Franklin images, this difference was only significant for the absolute values. Used for diagnosis (4-mm differential on the medial compartment), the passive dynamic images had lower diagnostic values (Se=59% and Sp=90%) than the series reported in the literature, which were marked by great heterogeneity.
The measurement of anterior drawer values on Telos(®) and Franklin dynamic X-rays is a reliable and reproducible measurement, particularly when using the medial compartment and differential measurements. This small series did not demonstrate a diagnostic value for the Franklin images, contrary to the Telos(®) X-rays. Used for diagnostic purposes, the Telos(®) images had a low sensitivity; consequently, they should be used preferentially for prognostic or therapeutic purposes.
Level III, prospective case-control study.
前交叉韧带（ACL）撕裂的临床诊断基于在股骨上显示胫骨的前侧半脱位。在以下任何一个方面，包括诊断（确认破裂的截断值）、预后（治疗效果）和治疗（影响治疗的松弛度），都可以在应力 X 光片上测量这种松弛度。
对于 ACL 撕裂，动态 X 光片的诊断价值较低。被动 Telos（®）X 光片具有更好的诊断价值、更好的放射学质量，并且比主动 Franklin 型 X 光片更容易进行。
前瞻性研究了 112 名患者（28 名女性，84 名男性；平均年龄 33.7 岁[范围，18-72 岁]），这些患者都有膝关节镜检查的指征。在接受关节镜治疗之前，对两个膝关节进行了两组图像拍摄：一组是在 Telos（®）设备上进行的 250N 被动前抽屉动态 X 光片，另一组是根据 Franklin（在脚踝处施加 7 公斤的重量以收缩四头肌）进行的主动前抽屉动态 X 光片。将 ACL 的关节镜评估（参考状态）与每个膝关节（内侧、外侧和平均）的前松弛度测量（绝对值和差值）进行比较，以确定两种放射学检查的诊断价值。
我们发现 70 名患者的 ACL“关节镜下撕裂”，32 名患者的 ACL“关节镜下健康”，10 名患者的 ACL“部分撕裂”。两名独立观察者对动态 X 光片（主动和被动）的前抽屉值的测量是可靠和可重复的（ICC>0.80），尤其是当使用内侧间隔时（ICC=0.96）和消除了观察者间测量误差和个体间松弛度变化的差值。就 X 光技术而言，主动图像更频繁地引起疼痛，并且放射学结果显示质量较差，不如 Telos 图像。在“健康 ACL”组中，无论是绝对值还是差值，Telos（®）图像的前抽屉值均明显小于“撕裂 ACL”组。对于 Franklin 图像，这种差异仅在绝对值上才有统计学意义。用于诊断（内侧间隔 4 毫米差值），被动动态图像的诊断价值（Se=59%和 Sp=90%）低于文献中报道的诊断价值，其差异很大。
Telos（®）和 Franklin 动态 X 光片的前抽屉值测量是一种可靠且可重复的测量方法，特别是当使用内侧间隔和差值测量时。本小系列研究并未显示 Franklin 图像具有诊断价值，而 Telos（®）X 光片则具有诊断价值。用于诊断目的，Telos（®）图像的灵敏度较低；因此，应优先将其用于预后或治疗目的。
III 级，前瞻性病例对照研究。
