Murgier Jérôme, Thomas Pierre, Reina Nicolas, Sylvie Rémi, Bérard Emilie, Cavaignac Etienne
Aguiléra Private Clinic, Ramsey Santé, Orthopedic Department, Biarritz, France.
Department of Orthopedic Surgery, Hôpital Pierre Paul Riquet, CHU Toulouse, Rue Jean Dausset, Toulouse, France.
Orthop J Sports Med. 2020 Jun 26;8(6):2325967120930200. doi: 10.1177/2325967120930200. eCollection 2020 Jun.
The anterolateral ligament (ALL) has been shown to contribute to the rotational stability of the knee. However, no clinical sign specific to ALL injury has been described.
PURPOSE/HYPOTHESIS: The primary aim of this study was to determine the concordance between pain elicited upon ALL palpation and ALL injury diagnosed by ultrasonography (US). The secondary aim was to look for a relationship between ALL injury and high-grade pivot shift. We hypothesized that an ALL lesion can be diagnosed clinically in an acute knee injury by palpating its tibial insertion.
Cohort study (diagnosis); Level of evidence, 2.
A total of 130 patients (89 men, 41 women; mean age, 27.2 ± 8.3 years) with an acute, isolated anterior cruciate ligament injury who were scheduled for ligament reconstruction were enrolled in this study. ALL palpation was carried out a mean 8.8 ± 3.2 days after injury. Preoperatively, ALL integrity was evaluated with US, and the pivot shift was determined under general anesthesia. The agreement between pain upon ALL palpation and ALL injury detected on US was determined by calculating the intraclass correlation coefficient (ICC), along with 95% CIs.
Distal palpation of the ALL tibial insertion elicited pain in 67 (51.5%) patients, and upon US the ALL was found to be damaged in 64 (49.2%) patients. The agreement between pain over the ALL tibial insertion and the ALL being damaged on US was excellent (ICC, 0.801; 95% CI, 0.730-0.855). Moreover, the clinical test had excellent sensitivity (92%; 95% CI, 88%-97%) and specificity (88%; 95% CI, 82%-93%). The agreement between pain at the ALL distal insertion and the pivot shift was good (ICC, 0.654; 95% CI, 0.543-0.742), and ALL palpation had excellent diagnostic accuracy for identifying rotational instability (sensitivity, 88% [95% CI, 82%-93%]; specificity, 97% [95% CI, 94%-100%]).
Palpation of the ALL tibial insertion highly correlates with ultrasonographic evidence of an ALL injury in the context of an acute knee injury. This simple test should become part of our standard examination when evaluating patients with acute knee injuries.
已证实前外侧韧带（ALL）有助于维持膝关节的旋转稳定性。然而，尚未有关于ALL损伤的特异性临床体征的描述。
目的/假设：本研究的主要目的是确定ALL触诊时引发的疼痛与超声（US）诊断的ALL损伤之间的一致性。次要目的是探寻ALL损伤与高级别轴移之间的关系。我们假设在急性膝关节损伤中，通过触诊ALL的胫骨止点可进行临床诊断。
队列研究（诊断）；证据等级，2级。
本研究纳入了130例计划进行韧带重建的急性、孤立性前交叉韧带损伤患者（89例男性，41例女性；平均年龄27.2±8.3岁）。ALL触诊在损伤后平均8.8±3.2天进行。术前，采用US评估ALL的完整性，并在全身麻醉下确定轴移情况。通过计算组内相关系数（ICC）及95%可信区间（CI），确定ALL触诊时的疼痛与US检测到的ALL损伤之间的一致性。
ALL胫骨止点远端触诊时，67例（51.5%）患者出现疼痛，而US检查发现64例（49.2%）患者的ALL受损。ALL胫骨止点处疼痛与US检查发现ALL受损之间的一致性良好（ICC，0.801；95%CI，0.730 - 0.855）。此外，该临床检查具有良好的敏感性（92%；95%CI，88% - 97%）和特异性（88%；95%CI，82% - 93%）。ALL远端止点处疼痛与轴移之间的一致性良好（ICC，0.654；95%CI，0.543 - 0.742），ALL触诊对识别旋转不稳定具有良好的诊断准确性（敏感性，88%[95%CI，82% - 93%]；特异性，97%[95%CI，94% - 100%]）。
在急性膝关节损伤中，ALL胫骨止点的触诊与ALL损伤的超声证据高度相关。在评估急性膝关节损伤患者时，这项简单的检查应成为我们标准检查的一部分。
