van der List Jelle P, Mintz Douglas N, DiFelice Gregory S
Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, NY, USA.
Spaarne Gasthuis Hospital, Department of Orthopaedic Surgery, Hoofddorp, Netherlands.
Adv Orthop. 2019 Mar 26;2019:5940195. doi: 10.1155/2019/5940195. eCollection 2019.
Recently, there has been a resurgence of interest in arthroscopic primary anterior cruciate ligament (ACL) repair. To date, no studies have assessed the role of postoperative magnetic resonance imaging (MRI) on the status and maturation of the repaired ligament. The goal of this study was therefore to assess (I) the accuracy of MRI on rerupture of the repaired ligament and (II) the maturation of the repaired ACL.
All postoperative MRIs of patients that underwent arthroscopic primary ACL repair were included. A musculoskeletal radiologist, blinded for MRI indication, surgery-MRI time interval, and clinical stability, retrospectively assessed the ligament continuity and graded ligament maturation as hypointense (similar to intact PCL), isointense (>50% similar to PCL), or hyperintense (<50% similar to PCL).
Thirty-seven MRIs were included from 36 patients. Mean age was 30 years (range: 14-57 years), and mean surgery-MRI interval was 1.5 years (range: 0.1-4.9 years). The radiologist recognized 6 out of 8 reruptures and 26 out of 29 intact ligaments (sensitivity 75%, specificity 90%, and accuracy 86%). Ligaments in the first year were more often hyperintense than after one year (60% vs. 11%, =0.02), most often isointense (60%) between one and two years, and more often hypointense after two years than before two years (56% vs. 10%, =0.03).
Postoperative MRI was found to accurately predict the rerupture of the primarily repaired ACL. Furthermore, it can be expected that the repaired ligament is hyperintense within the first year, while the signal becomes similar to the intact PCL after two years.
最近，关节镜下初次前交叉韧带（ACL）修复术再次引起了人们的关注。迄今为止，尚无研究评估术后磁共振成像（MRI）对修复韧带状态和成熟度的作用。因此，本研究的目的是评估（I）MRI对修复韧带再断裂的诊断准确性，以及（II）修复的ACL的成熟度。
纳入所有接受关节镜下初次ACL修复术患者的术后MRI检查结果。一名肌肉骨骼放射科医生对MRI检查指征、手术与MRI检查的时间间隔以及临床稳定性进行盲法评估，回顾性评估韧带的连续性，并将韧带成熟度分为低信号（类似于完整的后交叉韧带 [PCL]）、等信号（>50% 类似于PCL）或高信号（<50% 类似于PCL）。
纳入了36例患者中的37次MRI检查结果分析。平均年龄为30岁（范围：14 - 57岁），手术与MRI检查的平均时间间隔为1.5年（范围：0.1 - 4.9年）。放射科医生识别出8例再断裂中的6例以及29例完整韧带中的26例（敏感性75%，特异性90%，准确性86%）。术后第一年的韧带高信号情况比一年后更为常见（60% 对11%，P = 0.02），一到两年之间大多为等信号（60%），两年后低信号情况比两年前更为常见（56% 对10%，P = 0.03）。
研究发现术后MRI能够准确预测初次修复的ACL再断裂情况。此外，可以预期修复后的韧带在第一年为高信号，而两年后信号变得与完整的PCL相似。
