新型膝关节关节角度测量仪与同时行应力量线摄片在急性前交叉韧带完全性与部分性撕裂诊断中的比较。

Comparison between a Novel Knee Arthrometer and Simultaneous Stress Radiography for the Diagnosis of Complete and Partial Acute Anterior Cruciate Ligament Tears.

机构信息

Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China.

Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.

出版信息

Orthop Surg. 2024 Dec;16(12):3047-3058. doi: 10.1111/os.14243. Epub 2024 Sep 18.

DOI:10.1111/os.14243

PMID:39291822

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11608773/

Abstract

OBJECTIVES

The type of ligamentous tear and the degree of knee laxity have important guiding significance for the diagnosis and management of anterior cruciate ligament (ACL) tears. Instrumental measurement is necessary for ACL tears since physical examination and magnetic resonance imaging (MRI) cannot provide an objective and quantitative assessment of knee laxity. This study aimed to compare the application of a novel knee arthrometer and simultaneous stress radiography in differentiating between complete and partial acute ACL tears, and further assess the correlation between the two measurements.

METHODS

A total of 106 patients with complete acute ACL tears and 52 patients with partial acute ACL tears were included in the study. Preoperative arthrometry and simultaneous stress radiography were performed using the Ligs arthrometer at 90, 120, and 150 N to assess side-to-side difference (SSD) in anterior knee laxity. The optimal threshold was determined using the receiver operating characteristic (ROC) curve. The area under the ROC curve (AUC) was used to assess the diagnostic value of the measurement. Pearson's correlation coefficient was used to assess the correlation between the two measurements.

RESULTS

The optimal differential SSD thresholds in the Ligs arthrometer were 2.7 mm at 90 N, 3.8 mm at 120 N, and 4.6 mm at 150 N. Similarly, the optimal differential SSD thresholds in simultaneous stress radiography were 3.8 mm at 90 N, 5.1 mm at 120 N, and 5.6 mm at 150 N. The AUC analysis revealed that the Ligs arthrometer was fairly informative at 90 N (AUC = 0.851), 120 N (AUC = 0.878), and 150 N (AUC = 0.884), and simultaneous stress radiography was highly informative at 90 N (AUC = 0.910), 120 N (AUC = 0.925), and 150 N (AUC = 0.948). Moreover, the AUC of the combined measurements was 0.914 at 90 N, 0.931 at 120 N, and 0.951 at 150 N. A significantly strong correlation was found between the two measurements at 90 N (r = 0.743, p < 0.001), 120 N (r = 0.802, p < 0.001), and 150 N (r = 0.823, p < 0.001).

CONCLUSIONS

The Ligs arthrometer and simultaneous stress radiography proved to be valid diagnostic tools to differentiate between complete and partial acute ACL tears, with a strong correlation between the two measurements in SSD values. Compared with single instrumental measurement, the combination of the two measurements can further improve the diagnostic value in this regard.

摘要

目的

韧带撕裂的类型和膝关节松弛的程度对前交叉韧带（ACL）撕裂的诊断和治疗具有重要的指导意义。由于体格检查和磁共振成像（MRI）无法对膝关节松弛进行客观和定量评估，因此 ACL 撕裂需要进行器械测量。本研究旨在比较新型膝关节关节测量仪和同步应力量表在区分完全性和部分性急性 ACL 撕裂中的应用，并进一步评估两种测量方法的相关性。

方法

研究纳入了 106 例完全性急性 ACL 撕裂患者和 52 例部分性急性 ACL 撕裂患者。使用 Ligs 关节测量仪在 90、120 和 150 N 下进行术前关节测量和同步应力量表检查，以评估膝关节前向松弛的侧间差异（SSD）。使用受试者工作特征（ROC）曲线确定最佳阈值。ROC 曲线下面积（AUC）用于评估测量的诊断价值。使用 Pearson 相关系数评估两种测量方法之间的相关性。

结果

Ligs 关节测量仪在 90 N 时的最佳 SSD 差异阈值为 2.7 mm，在 120 N 时为 3.8 mm，在 150 N 时为 4.6 mm。同样，同步应力量表在 90 N 时的最佳 SSD 差异阈值为 3.8 mm，在 120 N 时为 5.1 mm，在 150 N 时为 5.6 mm。AUC 分析显示，Ligs 关节测量仪在 90 N（AUC=0.851）、120 N（AUC=0.878）和 150 N（AUC=0.884）时具有相当的信息性，同步应力量表在 90 N（AUC=0.910）、120 N（AUC=0.925）和 150 N（AUC=0.948）时具有高度的信息性。此外，联合测量的 AUC 在 90 N 时为 0.914，在 120 N 时为 0.931，在 150 N 时为 0.951。在 90 N（r=0.743，p<0.001）、120 N（r=0.802，p<0.001）和 150 N（r=0.823，p<0.001）时，两种测量方法之间存在显著的强相关性。