Wong Kenneth Pak Leung, Han Audrey XinYun, Wong Jeannie Leh Ying, Lee Dave Yee Han
Changi General Hospital Singapore, 2 Simei Street 3, Singapore, 529889, Singapore.
Knee Surg Sports Traumatol Arthrosc. 2017 Feb;25(2):411-417. doi: 10.1007/s00167-016-4211-1. Epub 2016 Jun 24.
The accuracy of magnetic resonance (MR) imaging in assessing meniscal and cartilage injuries in anterior cruciate ligament (ACL)-deficient knees as compared to arthroscopy was evaluated in the present study.
The results of all preoperative MR imaging performed within 3 months prior to the ACL reconstruction were compared against intraoperative arthroscopic findings. A total of 206 patients were identified. The location and type of meniscal injuries as well as the location and grade of the cartilage injuries were studied. The negative predictive value, positive predictive value, sensitivity, specificity and accuracy of MR imaging for these 206 cases were calculated and analysed.
In patients with an ACL injury, the highest incidence of concomitant injury was that of medial meniscus tears, 124 (60.2 %), followed by lateral meniscus tears, 105 (51.0 %), and cartilage injuries, 66 (32.0 %). Twenty-three (11.2 %) patients sustained injuries to all of the previously named structures. MR imaging was most accurate in detecting medial meniscus tears (85.9 %). MR imaging for medial meniscus tears also had the highest sensitivity (88.0 %) and positive predictive value (88.7 %), while MR imaging for cartilage injuries had the largest specificity (84.1 %) and negative predictive value (87.1 %). It was least accurate in evaluating lateral meniscus tears (74.3 %). The diagnostic accuracy of medial meniscus imaging is significantly influenced by age and the presence of lateral meniscus tears, while the duration between MR imaging and surgery has greater impact on the likelihood of lateral meniscus and cartilage injuries actually being present during surgery. The majority of meniscus tears missed by MR imaging affected the posterior horn and were complex in nature. Cartilage injuries affecting the medial femoral condyle or medial patella facet were also often missed by MR imaging.
MR imaging remains a reliable tool for assessing meniscus tears and cartilage defects preoperatively. It is most accurate when evaluating medial meniscus tears. However, MR imaging should be used with discretion especially if there is a high index of suspicion of lateral meniscus tears.
IV.
本研究评估了与关节镜检查相比，磁共振成像（MR）在评估前交叉韧带（ACL）损伤膝关节半月板和软骨损伤方面的准确性。
将ACL重建术前3个月内进行的所有术前MR成像结果与术中关节镜检查结果进行比较。共确定了206例患者。研究了半月板损伤的位置和类型以及软骨损伤的位置和分级。计算并分析了这206例病例MR成像的阴性预测值、阳性预测值、敏感性、特异性和准确性。
在ACL损伤患者中，合并损伤发生率最高的是内侧半月板撕裂，共124例（60.2%），其次是外侧半月板撕裂，共105例（51.0%），软骨损伤共66例（32.0%）。23例（11.2%）患者上述所有结构均有损伤。MR成像在检测内侧半月板撕裂方面最准确（85.9%）。内侧半月板撕裂的MR成像也具有最高的敏感性（88.0%）和阳性预测值（88.7%），而软骨损伤的MR成像具有最大的特异性（84.1%）和阴性预测值（87.1%）。其在评估外侧半月板撕裂方面最不准确（74.3%）。内侧半月板成像的诊断准确性受年龄和外侧半月板撕裂的存在显著影响，而MR成像与手术之间的时间间隔对外侧半月板和软骨损伤在手术时实际存在的可能性影响更大。MR成像漏诊的大多数半月板撕裂影响后角且性质复杂。影响内侧股骨髁或内侧髌骨关节面的软骨损伤也常被MR成像漏诊。
MR成像仍然是术前评估半月板撕裂和软骨缺损的可靠工具。在评估内侧半月板撕裂时最准确。然而，尤其是在高度怀疑外侧半月板撕裂时，应谨慎使用MR成像。
IV级。
