Clinique du sport, Paris, France.
Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
Knee Surg Sports Traumatol Arthrosc. 2024 Jul;32(7):1862-1870. doi: 10.1002/ksa.12258. Epub 2024 May 20.
The purpose of the study was to evaluate how the initial diagnostic tool used-specifically ultrasound (US) or magnetic resonance imaging (MRI)-for diagnosing proximal hamstring avulsion injury affects the delay before surgery and, secondarily, the outcomes of these injuries.
This was a retrospective analysis of prospectively collected data (2012-2020). It targeted patients primarily treated for proximal hamstring avulsion injury. It included all patients with a preoperative US and/or MRI. Patients were divided into two groups based on the initial diagnostic tool used (US-first vs. MRI-first groups). The primary outcomes measure was the time from initial injury to surgical intervention (surgical delay). The secondary outcomes were the Parisien Hamstring Avulsion Score, as well as the activity level as measured by the University of California, Los Angeles (UCLA) Activity Scale and Tegner Activity Scale.
The analysis included 392 patients with a mean age of 43.8 ± 13.6 years for the MRI-first group and 47.6 ± 12.0 years for US-first group. Patients in the MRI-first group had a significantly shorter median time from injury to surgery of 20.0 days (interquartile range [IQR]: 11.0-61.0) compared to 30 days (IQR: 18-74) in the US-first group. At the final follow-up (4.2 ± 2.2 years for the MRI-first group and 5.1 ± 1.9 years for the US-first group), the MRI-first group had significantly higher mean Tegner Activity Scale and UCLA scores than the US-first group: The Tegner Activity Scale was median 5 (IQR: 3-7) for the MRI-first group versus median 4 (IQR: 2-6) for the US-first group (p < 0.05). The UCLA scores were 7.9 ± 2.4 for the MRI-first group compared to 7.3 ± 2.4 for the US-first group (p < 0.05). This difference was more pronounced when comparing the MRI-first group with the patient-false negative initial ultrasound. No difference was found regarding the Parisien Hamstring Avulsion Score.
MRI as the initial diagnostic tool for proximal hamstring avulsion injury is associated with a shorter time to surgery and better postoperative outcomes in Tegner Activity Scale and UCLA scores, compared to US.
Level III.
本研究旨在评估用于诊断近端腘绳肌腱撕裂伤的初始诊断工具（具体为超声（US）或磁共振成像（MRI））对手术延迟的影响，其次是这些损伤的结果。
这是一项前瞻性数据的回顾性分析（2012-2020 年）。研究对象为主要接受近端腘绳肌腱撕裂伤治疗的患者。所有患者均接受术前 US 和/或 MRI 检查。根据初始诊断工具（US 组或 MRI 组）将患者分为两组。主要结局指标是从初始损伤到手术干预的时间（手术延迟）。次要结局指标为巴黎腘绳肌腱撕裂评分（Parisien Hamstring Avulsion Score）以及加利福尼亚大学洛杉矶分校（UCLA）活动量表和 Tegner 活动量表评估的活动水平。
共纳入 392 例患者，MRI 组的平均年龄为 43.8±13.6 岁，US 组为 47.6±12.0 岁。MRI 组患者的中位手术时间明显短于 US 组（20.0 天，四分位距 [IQR]：11.0-61.0 与 30 天，IQR：18-74）。在最后一次随访（MRI 组为 4.2±2.2 年，US 组为 5.1±1.9 年）时，MRI 组的 Tegner 活动量表和 UCLA 评分均明显高于 US 组：MRI 组的 Tegner 活动量表评分中位数为 5（IQR：3-7），US 组为 4（IQR：2-6）（p<0.05）。MRI 组的 UCLA 评分分别为 7.9±2.4，US 组为 7.3±2.4（p<0.05）。与初始 US 检查结果为假阴性的患者相比，MRI 组的这一差异更为显著。在 Parisien Hamstring Avulsion Score 方面，两组之间没有差异。
与 US 相比，MRI 作为近端腘绳肌腱撕裂伤的初始诊断工具，可缩短手术时间，在 Tegner 活动量表和 UCLA 评分方面改善术后结果。
III 级。
