Devitt Brian M, O'Sullivan Richard, Feller Julian A, Lash Nicholas, Porter Tabitha J, Webster Kate E, Whitehead Timothy S
Orthosport Victoria, 89 Bridge Road, Richmond, Melbourne, VIC, 3121, Australia.
Bridge Road Imaging, Richmond, Melbourne, 3121, VIC, Australia.
Knee Surg Sports Traumatol Arthrosc. 2017 Apr;25(4):1345-1351. doi: 10.1007/s00167-017-4538-2. Epub 2017 Apr 12.
There has been a renewed interest in the anterolateral structures of the knee, including description of the anterolateral ligament (ALL) as a distinct structure. Recognizing injury to the ALL is challenging, particularly given the subjective nature of physical examination. Consequently, focus has turned to magnetic resonance imaging (MRI) to reach a preoperative diagnosis of this region. The aim of this study was to examine the ability of 3-Tesla (3T) MRI to identify the ALL in ACL-injured patients compared to a matched control group of ACL-intact patients. The hypothesis was that the ALL would be more difficult to identify in ACL-injured patients compared to ACL-intact patients.
A prospective case control study was performed comparing 3T MRI scans of 63-patients with an ACL rupture with a control group of 64-patients without ACL injury. An experienced musculoskeletal radiologist and an orthopaedic surgeon evaluated the scans performed using standard knee protocols. The ALL was considered in three regions for analysis: femoral, meniscal, and tibial. The status of the ALL was determined as visualized or non-visualized, and the integrity was assessed as intact, attenuated, or focal discontinuity.
The detection rate of at least a portion of the ALL was 41/64 (64%) in the control group and 45/63 (72%) in the ACL-injured cohort, respectively. The entire length of the ALL could only be identified in 15/64 (23%) of the control group and 13/63 (21%) of the ACL-injured cases. In both groups, the visibility of the ALL was poorest at the femoral region and greatest at the tibial regions. The ALL, when visualized, was deemed to be intact in 55/63 (87%) of cases. Although the inter-observer reliability was excellent for detection of the ALL in the control group (κ = 0.86), this decreased to only moderate reliability in the ACL-injured group (κ = 0.52).
This study demonstrates that MRI alone should not be relied upon to make a diagnosis of ALL injury in the setting of concomitant ACL injury due to the inability to accurately visualize this structure consistently in its entirety. To make a diagnosis of ALL injury or anterolateral instability of the knee and clinical correlation remains essential.
Case-control study, Level III.
人们对膝关节前外侧结构重新产生了兴趣，包括将前外侧韧带（ALL）描述为一种独特的结构。认识到ALL损伤具有挑战性，特别是考虑到体格检查的主观性。因此，重点已转向磁共振成像（MRI）以对该区域进行术前诊断。本研究的目的是比较3特斯拉（3T）MRI在ACL损伤患者与匹配的ACL完整患者对照组中识别ALL的能力。假设是与ACL完整的患者相比，在ACL损伤的患者中识别ALL会更困难。
进行了一项前瞻性病例对照研究，比较了63例ACL断裂患者与64例无ACL损伤的对照组患者的3T MRI扫描结果。一位经验丰富的肌肉骨骼放射科医生和一位骨科医生评估了使用标准膝关节协议进行的扫描。ALL在三个区域进行分析：股骨、半月板和胫骨。ALL的状态被确定为可见或不可见，其完整性被评估为完整、减弱或局灶性中断。
对照组中至少一部分ALL的检出率分别为41/64（64%），ACL损伤队列中为45/63（72%）。ALL的全长仅在对照组的15/64（23%）和ACL损伤病例的13/63（21%）中得以识别。在两组中，ALL在股骨区域的可见性最差，在胫骨区域的可见性最好。当ALL可见时，在55/63（87%）的病例中被认为是完整的。尽管在对照组中观察者间对ALL检测的可靠性极佳（κ = 0.86），但在ACL损伤组中降至仅为中等可靠性（κ = 0.52）。
本研究表明，在伴有ACL损伤的情况下，不应仅依靠MRI来诊断ALL损伤，因为无法始终准确地完整显示该结构。要诊断ALL损伤或膝关节前外侧不稳定，临床相关性仍然至关重要。
病例对照研究，III级。
