联合使用裂隙征和截断三角形征有助于提高前交叉韧带损伤患者外侧半月板后根撕裂的术前磁共振成像诊断水平。
Combined use of cleft and truncated triangle signs helps improve the preoperative MRI diagnosis of lateral meniscus posterior root tears in patients with ACL injuries.
作者信息
Yoshihara Aritoshi, Mouton Caroline, Siboni Renaud, Nakamura Tomomasa, Sekiya Ichiro, Koga Hideyuki, Seil Romain, Nakagawa Yusuke
机构信息
Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan.
Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2025 Jul;33(7):2414-2421. doi: 10.1002/ksa.12597. Epub 2025 Jan 26.
PURPOSE
This study aimed to investigate whether combining the analysis of different magnetic resonance imaging (MRI) signs enhances the diagnostic accuracy of lateral meniscus posterior root tears (LMPRTs) in patients with anterior cruciate ligament (ACL) injuries. We hypothesised that analysing the cleft, ghost and truncated triangle signs and lateral meniscus extrusion (LME) measurement together would improve the preoperative MRI-based diagnosis of LMPRTs.
METHODS
This retrospective study used prospectively collected registry data from two academic centres, including patients undergoing primary or revision ACL reconstruction (ACLR) and LMPRT repair. The control group included age- and sex-matched (1:1) patients undergoing ACLR without any lateral meniscus tears. LME (mm) and the presence of cleft, ghost and/or truncated triangle signs were evaluated using preoperative MRI.
RESULTS
In total, 252 patients (126 per group) were included. Individually, the cleft and truncated triangle signs achieved the highest sensitivity (60% and 62%, respectively) and accuracy (>89%). The presence of either sign increased sensitivity to 79% and enabled the correct classification of 93% of ACL injuries as having or not having an LMPRT, with high specificity (95%) and good positive predictive value (74%). This combination was considered the most efficient in reducing false positives and false negatives. The LME (cutoff value: 2.2 mm) and ghost sign had lower sensitivities (50% and 14%, respectively) and accuracies (83% and 87%) and were not part of the optimal combination.
CONCLUSION
The cleft and/or truncated triangle signs on preoperative MRI reliably detected 79% of LMPRTs in this cohort, with high specificity (95%) and good positive predictive value (74%). This combination provides an effective method for achieving reasonable sensitivity while minimising false positives, aiding surgeons in preoperative diagnosis and planning for LMPRT repair.
LEVEL OF EVIDENCE
Level III.
目的
本研究旨在探讨综合分析不同的磁共振成像（MRI）征象是否能提高前交叉韧带（ACL）损伤患者外侧半月板后根部撕裂（LMPRT）的诊断准确性。我们假设，联合分析裂隙征、幽灵征、截断三角形征以及外侧半月板挤出（LME）测量值，将改善基于术前MRI的LMPRT诊断。
方法
这项回顾性研究使用了来自两个学术中心的前瞻性收集的登记数据，包括接受初次或翻修ACL重建（ACLR）及LMPRT修复的患者。对照组包括年龄和性别匹配（1:1）的接受ACLR且无任何外侧半月板撕裂的患者。使用术前MRI评估LME（毫米）以及裂隙征、幽灵征和/或截断三角形征的存在情况。
结果
总共纳入252例患者（每组126例）。单独来看，裂隙征和截断三角形征的敏感性最高（分别为60%和62%），准确性均大于89%。任一征象的存在将敏感性提高至79%，并能将93%的ACL损伤正确分类为伴有或不伴有LMPRT，具有高特异性（95%）和良好的阳性预测值（74%）。这种组合被认为在减少假阳性和假阴性方面最为有效。LME（截断值：2.2毫米）和幽灵征的敏感性较低（分别为50%和14%），准确性也较低（分别为83%和87%），并非最佳组合的一部分。
结论
术前MRI上的裂隙征和/或截断三角形征在该队列中可靠地检测出79%的LMPRT，具有高特异性（9%).
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