临床检查、磁共振成像和仪器松弛度在鉴别完全性与部分性前交叉韧带撕裂中的诊断价值。

The diagnostic value of clinical tests, magnetic resonance imaging, and instrumented laxity in the differentiation of complete versus partial anterior cruciate ligament tears.

机构信息

Lyon-Ortho-Clinic, Clinique de la Sauvegarde, Lyon, France.

出版信息

Arthroscopy. 2013 Mar;29(3):491-9. doi: 10.1016/j.arthro.2012.10.013. Epub 2013 Jan 20.

DOI:10.1016/j.arthro.2012.10.013

PMID:23343713

Abstract

PURPOSE

To evaluate the question of whether different arthroscopically confirmed anterior cruciate ligament (ACL) injury patterns have distinctive preoperative findings on clinical examination, instrumented laxity, and magnetic resonance imaging (MRI).

METHODS

Three hundred consecutive ACL-deficient patients with isolated ACL tears were evaluated with the Lachman test (LT), the pivot-shift test (PST), stress radiographs using the Telos Stress Device (Metax, Hungen, Germany), and MRI. After arthroscopic confirmation of the ACL injury, we grouped patients into 4 different ACL tear types (complete, partial anteromedial [AM] bundle intact, posterolateral [PL] bundle intact, and posterior cruciate ligament [PCL] healing), and partial tears were further evaluated for mechanical integrity and functionality of the remaining fibers.

RESULTS

PST grades of +2 and +3 were consistent with complete ACL tears (86%; P < .00001), whereas PST grades of 0 or +1 were strongly related to partial tears (76%; P < .00001). Instrumented laxity results showed a significant difference in side-to-side difference (SSD) of anterior tibial translation in complete tears (9.1 ± 3.4 mm) versus partial tears (5.2 ± 2.9 mm; P < .0001). Most PL-intact cases were "functional" (67%), with lower instrumented laxity values (SSD, 4.3 ± 2.3 mm) than the "nonfunctional" cases (SSD, 6.7 ± 2.9 mm; P < .001). The contrary was not observed for AM-intact cases (17% functional). Partial ACL tears with functional remaining fibers had PST grades of 0 or +1 and less than a 4 mm SSD in stress radiographs (sensitivity, 0.76; specificity, 0.90). Partial ACL tears with nonfunctional fibers had positive PST results and an SSD of anterior tibial displacement from 4 to 9 mm (sensitivity, 0.56; specificity, 0.92). Positive PST results and an SSD greater than 9 mm was recorded in complete ACL tears (sensitivity, 0.88; specificity, 0.96). MRI analysis revealed overlapping results between complete and partial tears.

CONCLUSIONS

Preoperative evaluation of different ACL tear types showed differences between complete and partial ACL tears with functional fibers in clinical examination and instrumented laxity tests. The combination of clinical tests and stress radiographs produced threshold values that distinguished complete from partial ACL tears, which may help the surgeon in the early identification of the presence of remaining functional fibers.

LEVEL OF EVIDENCE

Level III, case-control study.

摘要

目的

评估关节镜下不同前交叉韧带（ACL）损伤类型在临床检查、仪器松弛度和磁共振成像（MRI）方面是否存在独特的术前发现。

方法

对 300 例 ACL 缺失的 ACL 撕裂患者进行 Lachman 试验（LT）、枢轴移位试验（PST）、使用 Telos 应力装置（Metax，德国 Hungen）进行的应力射线照相和 MRI 评估。在关节镜确认 ACL 损伤后，我们将患者分为 4 种不同的 ACL 撕裂类型（完全、部分前内侧 [AM] 束完整、后外侧 [PL] 束完整和后交叉韧带 [PCL] 愈合），并进一步评估部分撕裂的剩余纤维的机械完整性和功能。

结果

PST 等级为+2 和+3 与完全 ACL 撕裂一致（86%；P<0.00001），而 PST 等级为 0 或+1 与部分撕裂强烈相关（76%；P<0.00001）。仪器松弛度结果显示完全撕裂（9.1±3.4mm）与部分撕裂（5.2±2.9mm；P<0.0001）之间存在明显的胫骨前移侧到侧差异（SSD）差异。大多数 PL 完整病例为“功能性”（67%），仪器松弛度值较低（SSD，4.3±2.3mm），而非“非功能性”病例（SSD，6.7±2.9mm；P<0.001）。AM 完整病例情况并非如此（17%功能性）。具有功能剩余纤维的部分 ACL 撕裂具有 PST 等级为 0 或+1 以及应力射线照相中 SSD 小于 4mm（灵敏度为 0.76；特异性为 0.90）。具有非功能剩余纤维的部分 ACL 撕裂具有阳性 PST 结果和胫骨前移 SSD 为 4 至 9mm（灵敏度为 0.56；特异性为 0.92）。完全 ACL 撕裂记录到阳性 PST 结果和 SSD 大于 9mm（灵敏度为 0.88；特异性为 0.96）。MRI 分析显示完全撕裂和部分撕裂之间存在重叠结果。