Perera N S, Joel J, Bunola J A
Department of Orthopaedics, Hull Royal Infirmary, Anlaby Road, Hull, East Yorkshire HU3 2JZ, UK.
Injury. 2013 Dec;44(12):1862-5. doi: 10.1016/j.injury.2013.07.024. Epub 2013 Aug 7.
Anterior cruciate ligament (ACL) tears are common injuries. Despite the diagnosis being in essence a clinical one, this has often proved unreliable. The objective of this study was to ascertain the delay to diagnosis of ACL injury from initial presentation and subsequent delay to review by a knee specialist.
The study involved a retrospective review of 130 patient case notes in a consecutive series of patients undergoing primary ACL reconstruction. Details regarding mechanism of injury, dates of initial and subsequent clinic attendances and the treating health-care professional were recorded. Other information included dates of magnetic resonance imaging (MRI) scans and when a patient first saw a knee specialist. From this, delays to clinical or radiological diagnosis were calculated.
There were 82 acute and 48 chronic ACL injuries. Overall, the initial treating practitioner made the diagnosis in only 25 patients, yielding a diagnostic rate of 19.2%. Diagnoses made on MRI scan accounted for 38.5% of cases, the remainder being diagnosed clinically. The mean delay to diagnosis of ACL rupture was 65 days, and only 53 patients were diagnosed within 30 days of initial presentation. A total of 15 patients had undergone arthroscopy, eight of which were diagnostic. The mean delay to consulting a soft-tissue knee surgeon was 165 days. In the acute group, the initial diagnostic rate was only 7.3% and the mean delay to diagnosis was 82 days, with 29 patients diagnosed within 30 days.
Despite 78% of the patients having a typical mechanism of ACL injury, and most attending acutely via the Emergency Department (ED), diagnosis of this common injury remains tardy. There has been at best only minor improvement in the diagnostic rate and delays, certainly of acute ACL injury, since a study in 1996. The overall clinical diagnostic rate remains disconcertingly low as does the delay to consulting a soft-tissue knee specialist.
前交叉韧带（ACL）撕裂是常见的损伤。尽管本质上诊断是临床诊断，但事实证明这往往并不可靠。本研究的目的是确定从初次就诊到诊断ACL损伤的延迟时间，以及随后到膝关节专科医生处复诊的延迟时间。
该研究对连续一系列接受初次ACL重建的130例患者的病例记录进行了回顾性分析。记录了损伤机制、初次和随后就诊日期以及治疗的医疗保健专业人员的详细信息。其他信息包括磁共振成像（MRI）扫描日期以及患者首次就诊膝关节专科医生的时间。据此计算出临床或放射学诊断的延迟时间。
有82例急性ACL损伤和48例慢性ACL损伤。总体而言，最初的治疗医生仅诊断出25例患者，诊断率为19.2%。MRI扫描诊断占病例的38.5%，其余为临床诊断。ACL撕裂诊断的平均延迟时间为65天，只有53例患者在初次就诊后30天内得到诊断。共有15例患者接受了关节镜检查，其中8例为诊断性检查。咨询膝关节软组织外科医生的平均延迟时间为165天。在急性组中，最初的诊断率仅为7.3%，诊断的平均延迟时间为82天，29例患者在30天内得到诊断。
尽管78%的患者具有典型的ACL损伤机制，且大多数通过急诊科（ED）急性就诊，但这种常见损伤的诊断仍然滞后。自1996年的一项研究以来，诊断率和延迟时间（尤其是急性ACL损伤）充其量只有轻微改善。总体临床诊断率仍然低得令人不安，咨询膝关节软组织专科医生的延迟时间也是如此。
