Johnson Shelby E, Kruse Ryan C, Boettcher Brennan J
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
Department of Orthopedic Surgery, Division of Sports Medicine, Mayo Clinic, Minneapolis, MN, USA.
Curr Rev Musculoskelet Med. 2024 Jun;17(6):171-184. doi: 10.1007/s12178-024-09894-y. Epub 2024 Apr 19.
This review evaluates the current understanding of the role of ultrasound in the diagnosis and treatment of meniscal disorders.
Ultrasound (US) demonstrates similar sensitivity and specificity when compared to magnetic resonance imaging in the evaluation of meniscal injuries when compared to arthroscopy. Meniscal extrusion (ME) under US can be a reliable metric to evaluate for meniscal root tears in knees with and without osteoarthritis (OA). Sonographic ME is associated with development of OA in knees without OA. US following allograft meniscal transplant may be useful in predicting graft failure. US findings can be used to screen for discoid menisci and may demonstrate snapping of a type 3 discoid lateral meniscus. Shear wave elastography for meniscal injuries is in its infancy; however, increased meniscal stiffness may be seen with meniscal degeneration. Perimeniscal corticosteroid injections may provide short term relief from meniscal symptoms, and intrameniscal platelet-rich plasma injections appear to be safe and effective up to three years. Ultrasound-assisted meniscal surgery may increase the safety of all inside repairs near the lateral root and may assist in assessing meniscal reduction following root repair. Diagnostic US can demonstrate with high accuracy a variety of meniscal pathologies and can be considered a screening tool. Newer technologies such as shear wave elastography may allow us to evaluate characteristics of meniscal tissue that is not possible on conventional imaging. US-guided (USG) treatment of meniscal injuries is possible and may be preferable to surgery for the initial treatment of degenerative meniscal lesions. USG or US-assisted meniscal surgery is in its infancy.
本综述评估了目前对超声在半月板疾病诊断和治疗中作用的理解。
与关节镜检查相比,在评估半月板损伤时,超声(US)与磁共振成像具有相似的敏感性和特异性。在有或没有骨关节炎(OA)的膝关节中,超声下的半月板挤压(ME)可作为评估半月板根部撕裂的可靠指标。在没有OA的膝关节中,超声检查发现的ME与OA的发生有关。同种异体半月板移植后的超声检查可能有助于预测移植物失败。超声检查结果可用于筛查盘状半月板,并可能显示Ⅲ型盘状外侧半月板的弹响。用于半月板损伤的剪切波弹性成像尚处于起步阶段;然而,半月板退变时可能会出现半月板硬度增加。半月板周围皮质类固醇注射可能会短期缓解半月板症状,半月板内注射富含血小板血浆在长达三年的时间内似乎是安全有效的。超声辅助半月板手术可能会提高外侧根部附近全内修复的安全性,并有助于评估根部修复后的半月板复位情况。诊断性超声能够高精度地显示各种半月板病变,可被视为一种筛查工具。诸如剪切波弹性成像等新技术可能使我们能够评估传统成像无法显示的半月板组织特征。超声引导(USG)治疗半月板损伤是可行的,对于退行性半月板损伤的初始治疗可能比手术更可取。USG或超声辅助半月板手术尚处于起步阶段。