后交叉韧带扣锁现象作为部分前交叉韧带撕裂的征象的潜力。
The potential of posterior cruciate ligament buckling phenomenon as a sign for partial anterior cruciate ligament tears.
机构信息
Department of Orthopaedics and Traumatology, Gazi University Faculty of Medicine, Emniyet Mahallesi, Mevlana Bulvarı No: 29 Yenimahalle, Ankara, Turkey.
Department of Radiology, Bilkent City Hospital, Ankara, Turkey.
出版信息
Arch Orthop Trauma Surg. 2024 May;144(5):2181-2187. doi: 10.1007/s00402-024-05270-0. Epub 2024 Mar 16.
INTRODUCTION
Diagnosis of a partial tear of the anterior cruciate ligament (ACL) can be challenging with physical examination and imaging techniques. Although magnetic resonance imaging (MRI) has high sensitivity and specificity for diagnosing complete ACL tears, its effectiveness may be limited when it is used to diagnose for partial tears. The hypothesis of the present study is that the posterior cruciate ligament (PCL) buckling phenomenon, which is a secondary sign of complete ACL tears on MRI, may be a useful method for diagnosing partial ACL tears.
MATERIALS AND METHODS
The data of 239 patients who underwent knee arthroscopy in a single institution between 2016 and 2022 were analyzed retrospectively. Patients were divided into three groups based on the condition of their ligaments: partial tears, complete tears and intact ligaments. To evaluate the buckling phenomenon on sagittal T2-weighted MRI, measurements of the posterior cruciate ligament angle (PCLA) and the posterior cruciate ligament-posterior cortex angle (PCL-PCA) were conducted in each group. Subsequently, the ability of these two measurement methods to distinguish partial tears from the other groups was assessed.
RESULTS
Both methods provided significantly different results in all three groups. Partial tears could be distinguished from intact ligaments with 86.8% sensitivity, 89.9% specificity when PCLA < 123.13° and 94.5% sensitivity, 93.2% specificity when PCL-PCA < 23.77°. Partial tears could be distinguished from complete tears with 79.5% sensitivity, 78.4% specificity when PCLA > 113.88° and with 86.1% sensitivity, 85.3% specificity when PCL-PCA > 16.39°.
CONCLUSION
The main finding of the present study is that the PCLA and PCL-PCA methods are useful on MRI for diagnosing partial ACL tears. PCLA value between 113°-123° and PCL-PCA value between 16°-24° could indicate a partial ACL tear. With these methods, it is possible to distinguish partial tears from healthy knees and reduce missed diagnoses. In addition, the differentiation of partial and complete tears by these methods may prevent unnecessary surgical interventions.
LEVEL OF EVIDENCE
Level III.
简介
体格检查和影像学技术对诊断前交叉韧带（ACL）部分撕裂具有一定挑战性。尽管磁共振成像（MRI）对诊断完全 ACL 撕裂具有高灵敏度和特异性，但在诊断部分撕裂时，其效果可能有限。本研究的假设是，后交叉韧带（PCL）扣锁现象（MRI 上完全 ACL 撕裂的次要征象）可能是诊断部分 ACL 撕裂的有用方法。
材料与方法
回顾性分析 2016 年至 2022 年在一家单机构行膝关节镜检查的 239 例患者的数据。根据韧带情况，将患者分为部分撕裂、完全撕裂和完整韧带三组。为了评估矢状面 T2 加权 MRI 上的扣锁现象，在每组中测量后交叉韧带角（PCLA）和后交叉韧带-后皮质角（PCL-PCA）。随后，评估这两种测量方法区分部分撕裂与其他组的能力。
结果
两种方法在三组中均提供了显著不同的结果。当 PCLA<123.13°时，PCLA 对区分部分撕裂与完整韧带的敏感度为 86.8%，特异度为 89.9%；当 PCL-PCA<23.77°时，敏感度为 94.5%，特异度为 93.2%。当 PCLA>113.88°时，PCLA 对区分部分撕裂与完全撕裂的敏感度为 79.5%，特异度为 78.4%；当 PCL-PCA>16.39°时，敏感度为 86.1%，特异度为 85.3%。
结论
本研究的主要发现是，PCLA 和 PCL-PCA 方法在 MRI 上对诊断部分 ACL 撕裂具有一定价值。PCLA 值在 113°-123°之间，PCL-PCA 值在 16°-24°之间可能提示 ACL 部分撕裂。使用这些方法，可以将部分撕裂与健康膝关节区分开来，减少漏诊。此外，这些方法对部分和完全撕裂的区分可能会避免不必要的手术干预。
证据等级
III 级。
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