Sliepka Joseph M, Saper Michael G, Sorey Woody, Mand Simran, Battan Shamele, Kweon Christopher Y, Gee Albert O, Schmale Gregory A, Hagen Mia S
Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington, USA.
Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington, USA.
Orthop J Sports Med. 2023 Jan 27;11(1):23259671221141664. doi: 10.1177/23259671221141664. eCollection 2023 Jan.
The prevalence of meniscal tears in patients with anterior cruciate ligament (ACL) injury increases with extended time between injury and ACL reconstruction.
PURPOSE/HYPOTHESIS: The purpose of this study was to determine if there is a relationship between time from magnetic resonance imaging (MRI) to ACL reconstruction and the predictive value of MRI to diagnose meniscal tears in the young active population. It was hypothesized that increased time between MRI and ACL reconstruction would lead to a decrease in the negative predictive value of MRI in diagnosing meniscal tears, as more injuries may accrue over time in the ACL-deficient knee.
Case series; Level of evidence, 4.
Included were patients aged 13 to 25 years at the authors' institution who underwent primary ACL reconstruction from January 2017 to June 2020. Time from MRI to surgery as well as descriptions of medial and lateral meniscal tears on both MRI and operative reports were documented. Time from MRI to surgery was divided into 4 intervals: 0 to 6 weeks, >6 weeks to 3 months, >3 to 6 months, and beyond 6 months. Multivariable analysis was used to determine the positive and negative predictive values of MRI in diagnosing a meniscal tear as compared with arthroscopic findings.
A total of 432 patients were included with a mean age of 17.9 ± 3.4 years. The mean time from MRI to surgery was 70.5 ± 98 days. There was a significant decrease in the negative predictive value of MRI to identify a medial meniscal tear in patients who underwent ACL reconstruction >6 months after imaging (odds ratio, 0.16 [95% CI, 0.05-0.53]; = .003). This same relationship was not shown for lateral meniscal tears, nor was any other predictor significant.
The utility of MRI to rule out a medial meniscal tear significantly diminished in the young athletic population when >6 months passed between MRI and ACL reconstruction. These data suggest these tears occur between the time of the MRI and surgery and that the medial meniscus is more susceptible than the lateral meniscus to new injury once the ACL has torn.
前交叉韧带（ACL）损伤患者半月板撕裂的发生率随损伤与ACL重建之间时间的延长而增加。
目的/假设：本研究的目的是确定从磁共振成像（MRI）到ACL重建的时间与MRI对年轻活跃人群半月板撕裂的诊断预测价值之间是否存在关联。假设MRI与ACL重建之间的时间增加会导致MRI诊断半月板撕裂的阴性预测价值降低，因为在ACL缺失的膝关节中，随着时间的推移可能会出现更多损伤。
病例系列；证据等级，4级。
纳入作者所在机构2017年1月至2020年6月期间接受初次ACL重建的13至25岁患者。记录从MRI到手术的时间以及MRI和手术报告中关于内侧和外侧半月板撕裂的描述。从MRI到手术的时间分为4个时间段：0至6周、>6周至3个月、>3至6个月以及超过6个月。采用多变量分析来确定与关节镜检查结果相比，MRI诊断半月板撕裂的阳性和阴性预测价值。
共纳入432例患者，平均年龄为17.9±3.4岁。从MRI到手术的平均时间为70.5±98天。在成像后>6个月接受ACL重建的患者中，MRI识别内侧半月板撕裂的阴性预测价值显著降低（比值比，0.16[95%CI，0.05 - 0.53]；P = .003）。外侧半月板撕裂未显示出相同的关系，也没有其他预测因素具有显著性。
在年轻运动员人群中，当MRI与ACL重建之间间隔>6个月时，MRI排除内侧半月板撕裂的效用显著降低。这些数据表明这些撕裂发生在MRI检查与手术之间的时间段，并且一旦ACL撕裂，内侧半月板比外侧半月板更容易受到新的损伤。
