Arastu M H, Grange S, Twyman R
Queens Medical Centre, Nottingham, UK,
Knee Surg Sports Traumatol Arthrosc. 2015 Apr;23(4):1201-5. doi: 10.1007/s00167-014-2947-z. Epub 2014 Mar 27.
Rupture of the anterior cruciate ligament (ACL) is a common injury, often presenting with a typical injury pattern. Historically, the literature indicates that the accuracy of diagnosis of ACL ruptures is poor at the initial medical consultation. The aims of this study were to determine: the mechanism of injury; changes in accuracy of diagnosis of ACL ruptures at initial presentation over the last decade; and the effect of subsequent delay in diagnosis and definitive treatment.
A prospective cohort of one hundred and thirty-two consecutive patients who underwent ACL reconstruction between 2005 and 2009 were analysed. The median age of the patients was 18 years (12-57). Sixteen patients were excluded due to chronic ACL injury.
One hundred and sixteen patients (117 ACL ruptures) were included in the analysis. A typical injury pattern was documented in 87 (74.4 %) of cases. The most common sporting activities associated with an ACL injury were football (35.3 %), skiing (21.6 %) and rugby (10.3 %). The majority of patients (67.5 %) sought medical attention within 1 week from time of injury. The correct diagnosis of an ACL rupture was made in 33 cases (28.2 %) at the initial medical consultation. The diagnosis was made following medical consultation in 13 (11.1 %) of cases with the use of magnetic resonance imaging and 6 (5.1 %) cases at arthroscopy. The median time to diagnosis was 6 weeks (0-192), and the median time to ACL reconstruction was 24 weeks (1-240). A delay in diagnosis of >6 months was associated with a medial meniscal tear rate of 72.2 % compared to 23.1 % if the diagnosis was made within 4 months of the injury (p < 0.05).
Despite a 'typical' mechanism of injury leading to ACL rupture, the rate of initial diagnosis in the UK still remains poor. This often leads to an unnecessary delay in the diagnosis and subsequent treatment and increases the risk of secondary injury to the knee. A delay in diagnosis of >6 months was associated with an increased medial meniscal tear rate. Patients who present with a 'typical' injury pattern should therefore be referred for further assessment by a knee specialist within 6 weeks.
IV.
前交叉韧带（ACL）断裂是一种常见损伤，常呈现典型的损伤模式。从历史来看，文献表明在初次就诊时ACL断裂的诊断准确性较差。本研究的目的是确定：损伤机制；过去十年中初次就诊时ACL断裂诊断准确性的变化；以及后续诊断和确定性治疗延迟的影响。
对2005年至2009年间连续接受ACL重建的132例患者进行前瞻性队列分析。患者的中位年龄为18岁（12 - 57岁）。16例因慢性ACL损伤被排除。
116例患者（117例ACL断裂）纳入分析。87例（74.4%）病例记录有典型损伤模式。与ACL损伤相关的最常见体育活动是足球（35.3%）、滑雪（21.6%）和橄榄球（10.3%）。大多数患者（67.5%）在受伤后1周内就医。初次就诊时33例（28.2%）正确诊断为ACL断裂。经会诊后，13例（11.1%）通过磁共振成像诊断，6例（5.1%）在关节镜检查时诊断。诊断的中位时间为6周（0 - 192），ACL重建的中位时间为24周（1 - 240）。诊断延迟>6个月与内侧半月板撕裂率72.2%相关，而损伤后4个月内诊断的该撕裂率为23.1%（p < 0.05）。
尽管导致ACL断裂有“典型”的损伤机制，但在英国初次诊断率仍然较低。这常常导致诊断和后续治疗不必要的延迟，并增加膝关节二次损伤的风险。诊断延迟>6个月与内侧半月板撕裂率增加相关。因此，出现“典型”损伤模式的患者应在6周内由膝关节专科医生进行进一步评估。
IV级
