Pacheco R J, Ayre C A, Bollen S R
Department of Physiotherapy, Bradford Teaching Hospitals Foundation Trust, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK.
J Bone Joint Surg Br. 2011 Feb;93(2):194-7. doi: 10.1302/0301-620X.93B2.25774.
We retrospectively reviewed the hospital records of 68 patients who had been referred with an injury to the posterolateral corner of the knee to a specialist knee surgeon between 2005 and 2009. These injuries were diagnosed based on a combination of clinical testing and imaging and arthroscopy when available. In all, 51 patients (75%) presented within 24 hours of their injury with a mean presentation at eight days (0 to 20) after the injury. A total of 63 patients (93%) had instability of the knee at presentation. There was a mean delay to the diagnosis of injury to the posterolateral corner of 30 months (0 to 420) from the time of injury. In all, the injuries in 49 patients (72%) were not identified at the time of the initial presentation, with the injury to the posterolateral corner only recognised in those patients who had severe multiple ligamentous injuries. The correct diagnosis, including injury to the posterolateral corner, had only been made in 34 patients (50%) at time of referral to a specialist knee clinic. MRI correctly identified 14 of 15 injuries when performed acutely (within 12 weeks of injury), but this was the case in only four of 15 patients in whom it was performed more than 12 weeks after the injury. Our study highlights a need for greater diligence in the examination and investigation of acute ligamentous injuries at the knee with symptoms of instability, in order to avoid failure to identify the true extent of the injury at the time when anatomical repair is most straightforward.
我们回顾性分析了2005年至2009年间因膝关节后外侧角损伤被转诊至膝关节专科外科医生处的68例患者的医院记录。这些损伤通过临床检查、影像学检查以及必要时的关节镜检查进行综合诊断。总共有51例患者（75%）在受伤后24小时内就诊，受伤后平均就诊时间为8天（0至20天）。共有63例患者（93%）就诊时存在膝关节不稳。从受伤到诊断出膝关节后外侧角损伤的平均延迟时间为30个月（0至420个月）。总共有49例患者（72%）在初次就诊时未被诊断出损伤，只有那些患有严重多发韧带损伤的患者才被识别出存在后外侧角损伤。在转诊至膝关节专科诊所时，只有34例患者（50%）得到了包括后外侧角损伤在内的正确诊断。急性损伤（受伤后12周内）时，MRI正确识别了15例损伤中的14例，但在受伤12周后进行MRI检查的15例患者中，只有4例得到了正确诊断。我们的研究强调，对于有膝关节不稳症状的急性韧带损伤，在检查和诊断时需要更加仔细，以避免在解剖修复最为直接的时机未能识别损伤的真实范围。
