Department of Orthopedic Surgery, Nanoori Seoul Hospital, Seoul, South Korea.
Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang, South Korea.
Arthroscopy. 2014 Apr;30(4):475-82. doi: 10.1016/j.arthro.2013.12.016.
The objective of this study was to compare the preoperative magnetic resonance imaging (MRI) diagnostic rates of meniscal injuries combined with acute anterior cruciate ligament (ACL) injuries, as well as traumatic meniscal injuries without ACL injuries.
From January 2005 through April 2013, 208 patients who underwent ACL reconstruction and 1,334 patients with traumatic meniscal tear injuries were examined by MRI and arthroscopy. Patients with chronic ACL injuries, revisions, fracture histories, or multiple-ligament injuries and patients with Outerbridge degenerative changes of grade 3 or greater were excluded, yielding 159 patients and 621 patients in the 2 groups, respectively. The medial meniscus (MM) and lateral meniscus (LM) examined by MRI and arthroscopy for findings of tears were compared in each group. The sensitivity, specificity, positive predictive value, and negative predictive value for MM and LM tears by MRI were compared and analyzed statistically.
The diagnostic sensitivity of MRI in the group with ACL injury was significantly lower than that in the ACL-intact group for the MM (P < .001) and LM (P = .040). The negative predictive value was also lower in the group with ACL injury for both the MM (P = .008) and LM (P < .001). There was no statistical difference in specificity and positive predictive value between the 2 groups.
This study showed that if a patient had an acute ACL tear, the sensitivity and negative predictive value of MRI for a meniscal tear were less than if there was no ACL tear, which led to the low diagnostic accuracy of MRI.
Level III, retrospective case-control study.
本研究旨在比较急性前交叉韧带（ACL）损伤合并半月板损伤以及单纯外伤性半月板损伤的术前磁共振成像（MRI）诊断率。
2005 年 1 月至 2013 年 4 月，对 208 例行 ACL 重建的患者和 1334 例外伤性半月板撕裂伤患者进行 MRI 和关节镜检查。排除慢性 ACL 损伤、翻修、骨折病史、多韧带损伤和外侧半月板退行性改变 3 级或以上的患者，分别纳入 159 例和 621 例患者。对 MRI 和关节镜检查的内侧半月板（MM）和外侧半月板（LM）撕裂伤进行比较。比较和分析 MRI 对 MM 和 LM 撕裂的敏感性、特异性、阳性预测值和阴性预测值。
ACL 损伤组的 MRI 诊断敏感性明显低于 ACL 完整组的 MM（P <.001）和 LM（P =.040）撕裂伤。ACL 损伤组的 MM（P =.008）和 LM（P <.001）撕裂伤的阴性预测值也较低。两组的特异性和阳性预测值无统计学差异。
本研究表明，如果患者存在急性 ACL 撕裂，MRI 对半月板撕裂的敏感性和阴性预测值低于没有 ACL 撕裂的患者，导致 MRI 的诊断准确性较低。
III 级，回顾性病例对照研究。
