San Antonio Military Medical Center, San Antonio, Texas, U.S.A..
San Antonio Military Medical Center, San Antonio, Texas, U.S.A.
Arthroscopy. 2018 Jul;34(7):2170-2176. doi: 10.1016/j.arthro.2018.01.057.
The purpose of this study is to determine the incidence of anterolateral ligament (ALL) tears on magnetic resonance imaging (MRI) in patients diagnosed with anterior cruciate ligament (ACL) tears. Furthermore, this study sought to determine the inter- and intraobserver reliability in diagnosing an ALL tear.
The MRI radiologic database at a community military hospital was queried for ACL tears over the period of January 2011 to April 2015. During this time, 181 MRIs were identified as having ACL tears. The MRIs were then independently reviewed by an orthopaedic surgeon and a musculoskeletal (MSK) trained radiologist. Both reviewers, independently confirmed the ACL tears, and the ALL was noted to be either torn, intact, or not visualized on axial, sagittal, and coronal images. Four weeks later the same MRIs were then reviewed for the presence and location of an ALL tear to determine inter- and intraobserver reliability.
The MSK radiologist found ALL tears on MRI in 28.2% of the cases, while the orthopaedic surgeon found ALL tears in 39.8% of the cases; 5.5% of the MRIs were characterized as having a nonvisualized ALL. The interobserver reliability was noted to have a kappa value of 0.333. The intraobserver reliability of the MSK radiologist and orthopaedic surgeon demonstrated a kappa value of 0.654 and 0.251, respectively.
This study shows that the majority of patients with a known ACL tear on MRI do not have a tear of the ALL. Additionally, the interobserver reliability of surgeons and radiologist is fair. In this study, the MSK radiologist had higher intraobserver reliability when looking for an ALL tear.
Level IV, case control study.
本研究旨在确定磁共振成像（MRI）诊断前交叉韧带（ACL）撕裂患者前外侧韧带（ALL）撕裂的发生率。此外，本研究还旨在确定诊断 ALL 撕裂的观察者间和观察者内可靠性。
在一家社区军事医院的 MRI 放射学数据库中，查询了 2011 年 1 月至 2015 年 4 月期间的 ACL 撕裂病例。在此期间，共确定了 181 例 MRI 诊断为 ACL 撕裂。然后由一名矫形外科医生和一名肌肉骨骼（MSK）放射科医生分别独立对 MRI 进行复查。两位审阅者均独立确认了 ACL 撕裂，并在轴位、矢状位和冠状位图像上记录了 ALL 是否撕裂、完整或未显示。4 周后，再次对相同的 MRI 进行审阅，以确定 ALL 撕裂的存在和位置，以确定观察者间和观察者内的可靠性。
MSK 放射科医生在 28.2%的病例中发现 MRI 上有 ALL 撕裂，而矫形外科医生在 39.8%的病例中发现 ALL 撕裂；5.5%的 MRI 表现为 ALL 未显示。观察者间可靠性的 Kappa 值为 0.333。MSK 放射科医生和矫形外科医生的观察者内可靠性的 Kappa 值分别为 0.654 和 0.251。
本研究表明，大多数 MRI 诊断为 ACL 撕裂的患者没有 ALL 撕裂。此外，外科医生和放射科医生的观察者间可靠性为中等。在本研究中，MSK 放射科医生在寻找 ALL 撕裂时具有更高的观察者内可靠性。
IV 级，病例对照研究。
