David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Am J Sports Med. 2021 Dec;49(14):3887-3897. doi: 10.1177/03635465211052526. Epub 2021 Nov 2.
The ability to predict meniscus tear reparability based on preoperative magnetic resonance imaging (MRI) is desirable for postoperative planning; however, the accuracy of predictive methods varies widely within the orthopaedic and radiology literature.
PURPOSE/HYPOTHESIS: The purpose was to determine if the higher resolution offered by 3-T MRI improves the accuracy of predicting reparability compared with previous investigations using 1.5-T MRI. Our hypothesis was that a higher field strength of 3-T MRI would result in improved reliability assessments and predictions of meniscus tear reparability compared with previous studies utilizing a 1.5-T MRI platform.
Cohort study (diagnosis); Level of evidence, 2.
A total of 44 patients who underwent meniscus repair were matched by age, sex, and body mass index to 43 patients who underwent partial meniscectomy. Overall, 2 orthopaedic surgeons and 2 musculoskeletal radiologists independently and blindly reviewed the preoperative MRI scans for all 87 patients. For each meniscus tear, reviewers evaluated the following criteria: tear pattern, tear length, tear distance from the meniscocapsular junction, tear thickness, and integrity of any inner meniscal fragment. The resultant data were then applied to 5 different approaches for predicting meniscal reparability.
The accuracy for all examined prediction methods was poor, ranging from 55% (3-point method) to 72% (classification tree method) among all reviewers. Interobserver reliability for examined criteria was also poor, with kappa values ranging from 0.07 (inner meniscal fragment status) to 0.40 (tear pattern).
MRI continues to be a poor predictor of meniscus tear reparability as assessed by arthroscopic criteria, even when using higher resolution 3-T scanners. Interobserver reliability in this setting can be poor, even among experienced clinicians.
术前磁共振成像（MRI）预测半月板撕裂可修复性的能力对于术后规划是理想的；然而，在矫形和放射学文献中，预测方法的准确性差异很大。
目的/假设：目的是确定 3-T MRI 提供的更高分辨率是否比以前使用 1.5-T MRI 的研究更能提高可修复性的准确性。我们的假设是，与以前使用 1.5-T MRI 平台的研究相比，3-T MRI 的更高场强将导致对半月板撕裂可修复性的可靠性评估和预测得到改善。
队列研究（诊断）；证据水平，2。
共有 44 名接受半月板修复的患者与年龄、性别和体重指数匹配的 43 名接受部分半月板切除术的患者相匹配。共有 2 名矫形外科医生和 2 名肌肉骨骼放射科医生对所有 87 名患者的术前 MRI 扫描进行独立和盲法评估。对于每个半月板撕裂，评估者评估了以下标准：撕裂模式、撕裂长度、撕裂距半月板关节囊连接的距离、撕裂厚度以及任何内部半月板碎片的完整性。然后将所得数据应用于 5 种不同的方法来预测半月板的可修复性。
所有检查的预测方法的准确性均较差，所有评估者的准确率范围为 55%（3 分法）至 72%（分类树法）。检查标准的观察者间可靠性也较差，kappa 值范围为 0.07（内部半月板碎片状态）至 0.40（撕裂模式）。
即使使用更高分辨率的 3-T 扫描仪，MRI 作为评估关节镜标准的半月板撕裂可修复性的预测方法仍然很差。在这种情况下，即使是经验丰富的临床医生，观察者间的可靠性也可能很差。
