Waldstein Wenzel, Merle Christian, Monsef Jad Bou, Boettner Friedrich
Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
Department of Orthopaedic and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstrasse 200 A, 69118, Heidelberg, Germany.
Knee Surg Sports Traumatol Arthrosc. 2015 Aug;23(8):2178-2184. doi: 10.1007/s00167-014-2994-5. Epub 2014 Apr 18.
The aim of this prospective study was to determine the clinical value of lateral radiographs and corresponding MRI scans in the preoperative evaluation of the functional integrity of the anterior cruciate ligament (ACL) in a consecutive series of 78 patients (93 knees) with medial compartment osteoarthritis.
All knees received standardised radiographs and MRI imagery. The wear pattern on the lateral radiograph was described based on a modified Keyes classification. On MRI, the ACL and the percentage of intact posterior cartilage in relation to the anteroposterior tibia width were assessed.
The MRI showed an intact ACL in 23 (25 %) knees, evidence of ACL degeneration in 54 (58 %) knees and a complete ACL tear in 16 (17 %) knees. All knees with an intact ACL showed ≥14 % intact posterior cartilage on sagittal MRI scans, except for one knee. All knees with a torn ACL demonstrated <14 % intact posterior cartilage. Of the 54 knees with evidence of ACL degeneration, eight knees had <14 % intact posterior cartilage similar to the wear pattern present in knees with torn ACLs. Out of the 24 knees with a torn or degenerated ACL and <14 % intact posterior cartilage on MRI, 23 (96 %) knees demonstrated posterior bony erosion on corresponding lateral radiographs.
The assessment of intact posterior tibial cartilage on MRI and lateral radiographs helps to identify knees with functional ACL insufficiency. MRI with assessment of both the ACL morphology and the underlying tibial wear pattern appears to provide additional clinical benefit in cases in which the extent of posterior bony erosion on the lateral radiograph cannot be assessed with confidence.
Diagnostic study, Level II.
本前瞻性研究旨在确定在连续78例（93膝）内侧间室骨关节炎患者中，侧位X线片及相应的MRI扫描在前交叉韧带（ACL）功能完整性术前评估中的临床价值。
所有膝关节均接受标准化X线片和MRI检查。基于改良的凯斯分类法描述侧位X线片上的磨损模式。在MRI上，评估ACL以及相对于胫骨干前后宽度的完整后交叉韧带百分比。
MRI显示23例（25%）膝关节的ACL完整，54例（58%）膝关节有ACL退变迹象，16例（17%）膝关节存在ACL完全撕裂。除1例膝关节外，所有ACL完整的膝关节在矢状面MRI扫描上显示后交叉韧带完整率≥14%。所有ACL撕裂的膝关节后交叉韧带完整率均<14%。在54例有ACL退变迹象的膝关节中，8例膝关节后交叉韧带完整率<14%，其磨损模式与ACL撕裂的膝关节相似。在MRI上ACL撕裂或退变且后交叉韧带完整率<14%的24例膝关节中，23例（96%）在相应的侧位X线片上显示有后方骨质侵蚀。
通过MRI和侧位X线片评估胫骨后交叉韧带的完整性有助于识别存在功能性ACL功能不全的膝关节。在无法可靠评估侧位X线片上后方骨质侵蚀程度的情况下，同时评估ACL形态和潜在胫骨磨损模式的MRI似乎能提供更多临床益处。
诊断性研究，二级。
