Department of Orthopaedic Surgery and Traumatology, Rouen Teaching Hospital Center, 1, rue de Germont, 76031 Rouen cedex, France.
Orthop Traumatol Surg Res. 2012 Nov;98(7):744-50. doi: 10.1016/j.otsr.2012.05.017. Epub 2012 Oct 16.
In patients with anterior cruciate ligament (ACL) tears, anterior laxity can be measured using stress radiographs or more recently introduced electronic measurement devices.
The GNRB(®) arthrometer offers a radiation-free method of measuring anterior knee laxity whose diagnostic value is identical to that of Telos(®) or Lerat stress radiographs.
One hundred and fifty-seven patients (40 years [18-69]) scheduled for knee arthroscopy were evaluated using the GNRB(®) and two series of stress radiographs of both knees, one obtained using a 250-N Telos(®) device and the other using the technique described by Lerat (posterior translation of the femur/tibia under a 9-kg loading device). Arthroscopic evaluation of the ACL served as the reference standard for assessing the diagnostic performance of the radiological and instrumental laxity measurements.
Under arthroscopic examination, the ACL was normal in 50.3%; "healed to roof of the notch" (partial tear) in 9.6%, "posterolateral bundle preserved" (partial tear) in 7.0%, "healed to the posterior cruciate ligament" (PCL) in 17.8%, and "empty notch" (complete tear) in 15.3%. In partial ACL tears, no significant differences in anterior laxity were found across the three measurement techniques. Telos(®) and GNRB(®) laxities were greater in the complete-tear group than in the normal-ACL, partial-tear, and healed-to-PCL groups. With the Lerat technique, the only significant differences were between the complete-tear group and the normal-ACL and partial-tear groups. Telos(®) and GNRB(®) showed similar diagnostic performance (sensitivity>62%, specificity>75%), whereas the Lerat technique lacked sensitivity (sensitivity=43.2%, specificity=82.7%) at 3mm.
Diagnostic performance was lower in our study than in earlier reports. The GNRB(®) performed as well as Telos(®). The non-irradiating nature of GNRB(®) assessments allows repeated measurements for therapeutic or diagnostic purposes.
Level III, prospective case-control study.
在患有前交叉韧带（ACL）撕裂的患者中，可以使用压力射线照片或最近引入的电子测量设备来测量前侧松弛度。
GNRB（®）关节测量仪提供了一种无辐射的方法来测量前膝松弛度，其诊断价值与 Telos（®）或 Lerat 压力射线照片相同。
对 157 名 40 岁（18-69 岁）的计划接受膝关节镜检查的患者使用 GNRB（®）和两种膝关节压力射线照片系列进行评估，一种使用 250-N Telos（®）设备获得，另一种使用 Lerat 技术（在 9-kg 加载装置下股骨/胫骨的后移）。关节镜检查评估 ACL 作为评估放射学和仪器松弛度测量诊断性能的参考标准。
在关节镜检查下，ACL 正常的占 50.3％；“愈合到切迹顶部”（部分撕裂）占 9.6％，“后外侧束保留”（部分撕裂）占 7.0％，“愈合到后交叉韧带”（PCL）占 17.8％，“空切迹”（完全撕裂）占 15.3％。在 ACL 部分撕裂中，三种测量技术在前侧松弛度方面没有显着差异。Telos（®）和 GNRB（®）的松弛度在完全撕裂组中大于正常 ACL、部分撕裂和愈合到 PCL 组。使用 Lerat 技术，只有在完全撕裂组与正常 ACL 和部分撕裂组之间才有显着差异。Telos（®）和 GNRB（®）显示出相似的诊断性能（敏感性> 62％，特异性> 75％），而 Lerat 技术的敏感性较低（敏感性= 43.2％，特异性= 82.7％）为 3mm。
在我们的研究中，诊断性能低于早期报告。GNRB（®）的表现与 Telos（®）一样。GNRB（®）评估的无辐射性质允许进行重复测量以用于治疗或诊断目的。
三级，前瞻性病例对照研究。
