Sports Medicine Center and Cartilage Restoration Program, The Ohio State University, Columbus, USA.
Arthroscopy. 2012 Nov;28(11):1728-37. doi: 10.1016/j.arthro.2012.03.018. Epub 2012 Jun 29.
Chondral defects within the patellofemoral compartment are common and lack the ability to heal on their own. Early detection of these lesions with a noninvasive modality would be beneficial in delaying or preventing their possible progression to osteoarthritis. We hypothesized that magnetic resonance imaging (MRI) is a sensitive, specific, and accurate imaging modality for the detection of patellofemoral chondral defects with substantial interobserver reliability and that MRI has a higher sensitivity, specificity, and accuracy for detecting patellar defects than trochlear defects.
A systematic review of multiple medical databases was performed by use of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol. Analysis of studies that reported diagnostic performance of MRI in the assessment of patellofemoral chondral defects (patella and trochlea), using arthroscopy as the reference gold standard, was performed. Sensitivity, specificity, accuracy, and interobserver reliability were reported. Significant heterogeneity across studies precluded meta-analysis.
MRI was more sensitive in detection of patellar (87%) versus trochlear (72%) defects. MRI was similarly specific for patellar (86%) and trochlear (89%) defects. MRI was similarly accurate for patellar (84%) and trochlear (83%) defects. Interobserver agreement was substantial to almost perfect for both patellar and trochlear defects.
MRI is a highly sensitive, specific, and accurate noninvasive diagnostic modality for the detection of chondral defects in the patellofemoral compartment of the knee, using arthroscopy as the reference gold standard. Although there was wide variability in the statistical parameters assessed, MRI was more sensitive for detection of patellar versus trochlear defects and similarly specific and accurate for patellar and trochlear defects. Interobserver reliability is substantial to near perfect in the assessment of these lesions, without a significant difference between patellar and trochlear defects.
Use of MRI may allow early detection of chondral defects within the patellofemoral compartment, enabling clinicians to adopt strategies to delay or prevent progression to osteoarthritis.
Level III, systematic review of Level I, II, and III studies.
髌股关节间的软骨缺损很常见，且自身无法愈合。通过非侵入性方式早期检测到这些病变，将有利于延迟或预防其可能进展为骨关节炎。我们假设磁共振成像（MRI）是一种敏感、特异、准确的检测髌股关节软骨缺损的影像学方法，且具有高度的观察者间可靠性，并且 MRI 对检测髌股关节软骨缺损（髌骨和滑车）具有比滑车更高的敏感性、特异性和准确性。
根据 PRISMA（系统评价和荟萃分析的首选报告项目）协议，对多个医学数据库进行了系统综述。分析了报告 MRI 在评估髌股关节软骨缺损（髌骨和滑车）方面的诊断性能的研究，以关节镜作为参考金标准。报告了敏感性、特异性、准确性和观察者间可靠性。由于研究之间存在显著的异质性，因此无法进行荟萃分析。
MRI 对检测髌骨（87%）缺损比滑车（72%）缺损更敏感。MRI 对髌骨（86%）和滑车（89%）缺损的特异性相似。MRI 对髌骨（84%）和滑车（83%）缺损的准确性相似。观察者间的一致性对于髌骨和滑车缺损都是中等至近乎完美的。
以关节镜作为参考金标准，MRI 是一种高度敏感、特异、准确的非侵入性诊断方法，可用于检测膝关节髌股关节间的软骨缺损。虽然评估的统计参数存在广泛的变异性，但 MRI 对检测髌骨缺损比滑车缺损更敏感，对髌骨和滑车缺损的特异性和准确性相似。在评估这些病变时，观察者间的可靠性是中等至近乎完美的，髌骨和滑车缺损之间没有显著差异。
使用 MRI 可能可以早期检测髌股关节间的软骨缺损，使临床医生能够采取策略来延迟或预防进展为骨关节炎。
三级，对一级、二级和三级研究进行系统综述。
