Mouton C, Theisen D, Meyer T, Agostinis H, Nührenbörger C, Pape D, Seil R
Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg.
Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany.
Knee Surg Sports Traumatol Arthrosc. 2015 Oct;23(10):2859-67. doi: 10.1007/s00167-015-3757-7. Epub 2015 Aug 30.
This study analysed whether associating the side-to-side difference in displacement and the slope of the load-displacement curve of anterior and rotational knee laxity measurements would improve the instrumental diagnosis of anterior cruciate ligament (ACL) ruptures and help to detect different types of ACL tears.
Anterior and rotational knee laxity was measured in 128 patients with an arthroscopically confirmed ACL injury and 104 healthy controls. Side-to-side differences were determined for three variables in anterior laxity: anterior displacement at 200 N (ATD200), primary compliance from 30 to 50 N (PCA) and secondary compliance from 100 to 200 N (SCA). Furthermore, four variables in rotational laxity were considered: internal and external rotation at 5 N m (IR5/ER5) and compliance from 2 to 5 N m (C IR/C ER). Receiver operating characteristic curves allowed to determine thresholds, specificities and sensitivities to detect ACL lesions, based on single variables considered and combinations thereof.
Sensitivity and specificity reached, respectively, 75 and 95 % for ATD200 (threshold: 1.2 mm) and 38 and 95 % for IR5 (threshold: 3.2°). If either two out of the three variables were positive for anterior laxity or both IR5 and C IR were positive, 81 % of patients were identified without a false positive. All patients for whom ATD200 was >3.7 mm, PCA > 48 μm/N or SCA > 17.5 µm/N had ACL remnants that were either totally resorbed or healed on the posterior cruciate ligament.
Combined instrumented anterior and rotational knee laxity measurements have excellent diagnostic value for ACL injury, provided that several measurements be considered concomitantly.
Diagnostic study, Level III.
本研究分析了将膝关节前向和旋转松弛度测量中位移的左右差异与负荷 - 位移曲线的斜率相结合，是否会改善前交叉韧带（ACL）断裂的仪器诊断，并有助于检测不同类型的ACL撕裂。
对128例经关节镜证实为ACL损伤的患者和104例健康对照者进行膝关节前向和旋转松弛度测量。确定前向松弛度三个变量的左右差异：200 N时的前向位移（ATD200）、30至50 N时的初始顺应性（PCA）和100至200 N时的二次顺应性（SCA）。此外，还考虑了旋转松弛度的四个变量：5 N·m时的内旋和外旋（IR5/ER5）以及2至5 N·m时的顺应性（C IR/C ER）。基于所考虑的单个变量及其组合，通过受试者操作特征曲线确定检测ACL损伤的阈值、特异性和敏感性。
ATD200（阈值：1.2 mm）的敏感性和特异性分别达到75%和95%，IR5（阈值：3.2°）的敏感性和特异性分别为38%和95%。如果前向松弛度的三个变量中有两个为阳性，或者IR5和C IR均为阳性，则可识别出81%的患者且无假阳性。所有ATD200>3.7 mm、PCA>48μm/N或SCA>17.5µm/N的患者，其ACL残端要么完全吸收，要么在后交叉韧带上愈合。
联合进行仪器化的膝关节前向和旋转松弛度测量对ACL损伤具有出色的诊断价值，前提是同时考虑多项测量。
诊断性研究，III级。
