一种新型关节镜检查诊断膝关节后外侧旋转不稳定的有效性：外侧隐窝贯通试验。

Validity of a novel arthroscopic test to diagnose posterolateral rotational instability of the knee joint: the lateral gutter drive-through test.

机构信息

Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China.

出版信息

Arthroscopy. 2013 Apr;29(4):695-700. doi: 10.1016/j.arthro.2012.10.031. Epub 2013 Feb 1.

DOI:10.1016/j.arthro.2012.10.031

PMID:23375666

Abstract

PURPOSE

The purpose of this study was to assess the validity of a newly developed arthroscopic test, termed the lateral gutter drive-through (LGDT) test, to diagnose posterolateral rotational instability (PLRI) of the knee joint.

METHODS

Between October 2009 and February 2012, 115 consecutive patients were enrolled into this prospective diagnostic study. The dial test was used as the gold standard for diagnostic reference. According to the dial test, the patients were divided into a study group (35 patients) and a control group (80 patients). The LGDT test was performed on all patients during arthroscopic surgery. The sensitivity and specificity of the LGDT test were calculated. Sensitivities were also calculated in subgroups defined by injury patterns and extents of tibial external rotational instability.

RESULTS

The sensitivity and specificity of the LGDT test were calculated as 91.4% and 93.8%, respectively. In subgroup analyses the sensitivity of detection for acute PLRI was 90% versus 92% in chronic cases (P = .849). Popliteus femoral "peel-off" lesions were detected with a sensitivity of 100% versus 87.0% in cases of non-peel-off lesions (P = .536). The sensitivity of detecting isolated external rotational instability versus combined instability (rotational and varus) was 90.5% versus 92.8% (P = .805). The sensitivity of the LGDT test was correlated with the extent of tibial external rotational instability (P < .001).

CONCLUSIONS

This study showed that the LGDT test is a reliable method and can be used for diagnosing PLRI of the knee joint. The highest sensitivity was observed in patients with the femoral peel-off injury pattern. The sensitivity of the LGDT test was correlated with the extent of tibial external rotational instability and was significantly higher in patients with an increase in tibial external rotation by more than 10°.

LEVEL OF EVIDENCE

Level I, diagnostic study: testing of previously developed criteria in a series of consecutive patients.

摘要

目的

本研究旨在评估一种新开发的关节镜检查方法，即外侧隐窝贯通试验（LGDT），用于诊断膝关节后外侧旋转不稳定（PLRI）的有效性。

方法

2009 年 10 月至 2012 年 2 月，连续纳入 115 例患者进行前瞻性诊断研究。以 Dial 试验作为诊断参考的金标准。根据 Dial 试验，患者分为研究组（35 例）和对照组（80 例）。所有患者均在关节镜手术中进行 LGDT 检查。计算 LGDT 检查的敏感性和特异性。还根据损伤模式和胫骨外旋不稳定程度定义亚组计算了敏感性。

结果

LGDT 检查的敏感性和特异性分别为 91.4%和 93.8%。在亚组分析中，急性 PLRI 的检测敏感性为 90%，慢性病例为 92%（P=.849）。股二头肌股骨“剥离”病变的检出率为 100%，非剥离病变为 87.0%（P=.536）。单独外旋不稳定与合并不稳定（旋转和内翻）的检测敏感性分别为 90.5%和 92.8%（P=.805）。LGDT 检查的敏感性与胫骨外旋不稳定程度相关（P <.001）。